Free tool

Your perimenopause appointment prep sheet

Fill it in on screen, then print it or save it as a PDF. Visits are short: arriving with this page helps your clinician see the whole picture fast.

Nothing you type is sent or saved. It stays in this browser tab.

1. Why I am comingMy top three concerns, in order

Not sure how to describe them? Take the 2-minute symptom check and print the result with this sheet.

2. My cycle over the past yearFirst day of my last periodTypical cycle length now (days)Changes I have noticed (flow, clots, spotting, skipped periods)

3. Everything I takePrescription medicines, birth control, supplements and doses

4. Family and personal historyDetails (who, at what age)

5. Questions I want to ask

Could my symptoms be perimenopause, and what else should we rule out? Do I need any tests, and what would they change? Am I a candidate for hormone therapy? What are the benefits and risks for me? What non-hormonal options fit my situation? What should I do about sleep, mood or bleeding changes right now? When should I come back, and what would make me call sooner?

My own questions

More ideas: questions to ask your doctor and how to talk about hormone therapy.

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