Perimenopause Symptom Tracker: What to Track and Why It Helps

Many women start with a note on their phone. Every strange symptom from the last year, typed in at 3am or in the car park, and usually shown a little apologetically, as if it's too much to bring to an appointment.

It isn't. Sleep that's gone, a temper that doesn't feel like yours, stiff hands in the morning, words that go missing halfway through a sentence. On their own, each one sounds like a busy life. Written down over a few weeks, they start to make sense together.

So this post goes through what to track, how to keep it simple, and how to use it when you book.

Why the pattern tells you more than 1 blood test

In perimenopause your hormones go up and down from one week to the next. FSH (follicle-stimulating hormone, the message your brain sends to your ovaries) and oestrogen can look completely normal one week and very different the next. So 1 blood test shows you 1 day, and 1 normal result doesn't rule perimenopause out.

That's why, if you're over 45, perimenopause and menopause are usually diagnosed from your symptoms and from how your periods have changed, rather than from a blood test. Between 40 and 45, a blood test can help alongside your symptoms. Under 40, testing is part of it, and it needs checking promptly.

Blood tests still matter. They just do a different job. An underactive thyroid, low iron, low vitamin D or blood sugar creeping up can all feel a lot like perimenopause, and testing is how we find them. What it can't show is how the last 3 months have actually felt, and that's what your notes are for.

What to track

You don't need to track everything. These are the areas we go through in a consultation, so they're the ones that help most when they're written down.

• Sleep. Getting to sleep, waking at 3am and staying awake, and waking up tired however long you were in bed.
• Flushes and night sweats. Roughly how many in a day or a night, and whether they wake you. Changing your top at 3am counts.
• Mood. Low, flat, anxious, tearful, or a much shorter fuse than usual. If you still have periods, note when in your cycle it's worst.
• Periods and bleeding. The date each period starts, how many days it lasts and how heavy it is. Any bleeding between periods or after sex goes on the list too, with the date.
• Brain fog. Losing words, losing your thread, walking into a room and forgetting why you came in.
• Joints and muscles. Stiff mornings, aching hands, or muscles that hurt more than the exercise explains.
• Bladder and vagina. Needing the loo more often or more urgently, leaking, infections that keep coming back, dryness or soreness. The Vaginal and Bladder Health guide goes through these in more detail.
• Libido. Interest in sex, and how easy it is to feel anything when you do.

The last 2 are the ones women leave off their notes most often. They're common, there are options for both, and I'd much rather see them on the list than not.

How to keep it simple

Once a week is enough for most women. Pick the same evening, score each area from 0 (not at all) to 3 (a lot), and add 1 line about anything that stood out. It takes about 5 minutes.

Keep going for 8 to 12 weeks. That's roughly how long it takes for a pattern to show, and roughly how long many lifestyle and non-hormonal changes need before you can tell whether they're helping.

Write down anything you start or stop, with the date: a new medicine, a change to your contraception, cutting back on alcohol, starting strength training, or a supplement such as magnesium. Then when something changes, you can see what changed alongside it. Food supplements should not replace a varied, balanced diet and a healthy lifestyle.

If you'd rather not make your own, the Symptom Tracker is free and does this for you, week by week, with the same areas laid out so the pattern is in front of you when you talk to a clinician.

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What the pattern can show, and what it can't

A tracker doesn't tell you what's causing your symptoms. It shows you the shape of them, and that's what makes it so useful in a consultation. These are the kinds of patterns that help:

• Mood, sleep or headaches that get worse in the week or so before a period, then ease once it starts.
• Sleep going first, with mood and focus following a few weeks later.
• Night sweats that wake you, so the tiredness the next day finally makes sense.
• Bladder or vaginal symptoms that slowly get worse, rather than coming and going.

Sometimes the pattern doesn't fit perimenopause at all, and that's useful too. Tiredness that's there every day of the month, whatever your cycle is doing, can be a sign of something else, such as low iron or an underactive thyroid. That's where a blood test does its job.

It also gives you a before. If you start treatment, the same tracker is how you and your clinician see whether it's helping, and what still needs work.

How to bring it to your consultation

If you've got a note on your phone with every strange symptom from the last year, bring it. Your tracker, your list, a photo of the calendar where you marked your periods: all of it helps. A few things make it even more useful:

• Put the 3 things bothering you most at the top. That's where we start.
• Add the dates of your periods over the last 6 to 12 months, if you have them.
• List your medicines and supplements, and anything you've already tried.
• Bring any recent blood results, normal ones included. Ask for the numbers, not just "normal".

If you'd like to read up on the choices first, the Your Options guide goes through hormonal and non-hormonal options in plain English.

The Menopause Consultation is 45 minutes online, by video or voice call, wherever you live in the UK. We go through your story and your tracker together, talk through your options and decide on a plan. Where treatment is right for you, it can start without waiting for a blood test, and we review it together.

If you'd like to go through yours, you can book a Menopause Consultation here. If something other than menopause is going on, like your periods, weight, gut, skin or hair, the Women's Health Consultation is the one for you.

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Every Sunday morning I send out my newsletter, Beyond Prescriptions, with 1 women's health lesson and what to do with it. You can sign up here.

Debora Tentis, Women's Health Pharmacist.