Rollcall Research

Perimenopause symptom checklist for your GP appointment (free printable)

A free two-page checklist you fill in at home over a week or two, then take into the appointment. It gives you a record you can take to your doctor instead of trying to remember three months of symptoms in ten minutes.

By Evan Cole · Last reviewed 8 Oct 2026
Drafted with AI assistance from the sources listed; checked by Evan Cole.

Download PDF (A4) Download PDF (US Letter)

Free for personal use, no sign-up. Prefer Gumroad? Get the same free file on Gumroad.

Preview of the free perimenopause symptom checklist page, with tick boxes for symptoms and columns for how often and how strong
Please note: this is a record-keeping page, not a diagnostic tool and not medical advice. It cannot tell you what is causing your symptoms. It gives you a record you can take to your doctor. Evan, who makes it, is not a clinician; see how these pages are made.

What is on it

  • Fourteen commonly reported symptoms to tick, including hot flushes, night sweats, sleep, mood, brain fog, joint aches and changes to your periods, plus two blank rows for your own. The list follows the symptoms the NHS lists for menopause and perimenopause.
  • Columns for how often each one happens, how strong it has been on a 1 to 5 scale, and roughly when it started.
  • Space for the date of your last period and anything you already take, including HRT and supplements.
  • A second page for the questions you want to ask, most important first, and what you and your GP agreed.

How to fill it in

  1. Print it, or open it in GoodNotes, Notability or Xodo.
  2. Start a week or two before the appointment, not the night before, so it reflects ordinary days as well as bad ones.
  3. Tick each symptom you notice and fill in how often, how strong (1 to 5) and roughly when it started.
  4. Write your questions on page 2 in order of importance, so the first one gets asked even if time runs short.
  5. Take it with you and hand it over or read from it. Note what you agreed in the box at the bottom.

The NHS says to contact your GP if you think you have symptoms of menopause or perimenopause and want to know what your options are. This checklist is for that conversation.

Download PDF (A4) Download PDF (US Letter)

Free for personal use, no sign-up. Prefer Gumroad? Get the same free file on Gumroad.

Want the whole planner?

This page comes from The Steady Season perimenopause and menopause tracker, a 48-page tracker with 24 weekly symptom and cycle pages, an HRT and supplement log, a sleep tracker and four doctor-visit summaries. It is on Gumroad, and also on Etsy in the Rollcall Research shop.

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