Name:
Date:
Physical Symptoms
Hot flushes
Night sweats
Sleep disturbances
Fatigue
Emotional & Cognitive Symptoms
Mood swings
Anxiety
Low mood
Hormonal & Other Symptoms
Bloating
Skin changes
Hair thinning
Weight changes
Digestive issues
Joint or muscle aches
Headaches
Brain fog
Memory lapses
Irritability
Let’s Chat!
Which symptoms are most affecting your daily life?