Example · page 1 of 2
Symptom summary for my appointment
1I would like to discuss whether HRT is an option for me.
In brief
For over a year I have had severe sleep problems, physical and mental exhaustion and moderate hot flushes. I wake three to four times a night.
2Menopause Rating Scale, self-reported
21 of 44 · physical 9 · mood and energy 9 · bladder and intimacy 3
| Sleep problems | severe |
| Physical and mental exhaustion | severe |
| Hot flushes, sweating | moderate |
| Anxiety | moderate |
| Joint and muscle discomfort | mild |
3In my words
“I'm so tired I've made mistakes at work, and I snap at my children.”
Tried so far
Exercise and less caffeine; magnesium.
4Please take into account: migraine with aura.
Patient-prepared summary using the Menopause Rating Scale. Not a diagnosis.

