Patient Handout

Menopause & Perimenopause Checklist

Print this page and bring it to your visit. Mark the symptoms you’re experiencing, note which labs you’ve had or need, and review the hormone-therapy considerations with your provider.

Tip: use your browser’s print dialog to save as PDF.

Name:
Date:
Age:
LMP:

1. Symptoms

Check each symptom you’ve noticed, even occasionally.

Vasomotor

  • Hot flashes
  • Night sweats
  • Daytime flushing
  • Sudden sweating

Sleep

  • Difficulty falling asleep
  • Waking in the night
  • Early-morning waking
  • Restless / unrefreshing sleep
  • Daytime fatigue

Mood

  • Irritability
  • Mood swings
  • Anxiety
  • Low mood / depression
  • Tearfulness
  • Feeling overwhelmed

Cognitive

  • Brain fog
  • Memory lapses
  • Difficulty concentrating
  • Trouble finding words

Energy & Body

  • Low energy / fatigue
  • Reduced stamina
  • Joint aches
  • Muscle aches
  • Weight gain
  • Bloating
  • Breast tenderness

Cycle Changes

  • Irregular periods
  • Heavier bleeding
  • Lighter / shorter cycles
  • Longer cycles
  • Spotting between periods
  • Skipped periods

Sexual & Genitourinary

  • Vaginal dryness
  • Painful intercourse
  • Low libido
  • Urinary urgency
  • Urinary frequency
  • Recurrent UTIs
  • Urinary leakage

Skin, Hair & Other

  • Dry skin
  • Thinning hair
  • Hair loss
  • Acne
  • Brittle nails
  • Changes in body odor
  • Headaches / migraines
  • Dizziness
  • Heart palpitations
  • Tingling / numbness
  • Tinnitus
  • Reduced bone density
  • Loss of muscle mass

2. Helpful Labs & Why

No labs are required to confirm menopause — it is diagnosed clinically. These labs can, however, give helpful insight into your overall health. Mark the ones you’ve had or would like to discuss; your provider will tailor the panel to you.

  • FSH — Rises as ovaries slow — offers insight into hormonal status (no lab is needed to confirm menopause, which is diagnosed clinically)
  • Estradiol (E2) — Main estrogen — low in menopause; offers insight into hormonal decline
  • LH — Paired with FSH — rises with ovarian decline
  • Progesterone — Confirms ovulation; often low / anovulatory in perimenopause
  • TSH + Free T4 — Thyroid disease mimics menopause symptoms — rule out or confirm
  • TPO Antibodies — Autoimmune thyroid (Hashimoto’s) — common in midlife women
  • CBC — Rules out anemia from heavy bleeding or fatigue
  • Ferritin — Iron stores — low causes fatigue and hair loss
  • Vitamin D — Bone health; deficiency is common and worsens symptoms
  • Vitamin B12 — Energy, nerve health & mood — deficiency causes fatigue, brain fog, and tingling
  • Lipid Panel — Cardiovascular risk rises after menopause — baseline + monitor
  • Lipoprotein(a) — Inherited cardiovascular risk marker — high levels raise heart attack & stroke risk independent of other lipids
  • HbA1c / Fasting Glucose — Metabolic changes and weight gain — screen for insulin resistance
  • Comprehensive Metabolic Panel — Liver & kidney baseline before starting hormones
  • DHEA-S — Adrenal androgen — often elevated in perimenopause, then declines in menopause; affects libido, energy, mood
  • Total & Free Testosterone — Libido, muscle, energy (low but relevant in women)
  • SHBG — Binds sex hormones — affects the free, active hormone levels
  • AMH — Ovarian reserve — very low at menopause (less useful for perimenopause diagnosis)
  • hsCRP — Inflammation & cardiovascular risk marker
  • Homocysteine — Cardiovascular risk marker
  • Cortisol — Stress / adrenal function — affects sleep & energy
  • Prolactin — Rules out other causes of menstrual changes or low libido

3. Hormone Therapy: Conditions to Flag

Some conditions make hormone therapy unsafe or require extra care. Review these with your provider.

Usually Contraindicated

  • Current or past breast cancer (estrogen-receptor positive)
  • Other estrogen-dependent cancer (endometrial, ovarian)
  • Unexplained vaginal bleeding
  • Active or past blood clots (DVT or pulmonary embolism)
  • History of stroke or transient ischemic attack (TIA)
  • Active liver disease
  • Known thrombophilia (e.g. Factor V Leiden, protein C/S deficiency)
  • Pregnancy
  • Severe hypertriglyceridemia
  • Known allergy / hypersensitivity to hormone therapy

Use With Caution — Discuss

  • Migraine with aura
  • Uncontrolled hypertension
  • Active gallbladder disease or gallstones
  • Endometriosis
  • Uterine fibroids
  • Strong family history of breast cancer / BRCA carrier
  • Smoking (especially with oral estrogen)
  • Obesity / high BMI
  • Starting hormones after age 60, or more than 10 years past menopause
  • History of melanoma

4. When Transdermal Hormones Are Preferred

Transdermal (patch, gel, or spray) estrogen bypasses the liver’s first pass, lowering the risk of blood clots and stroke and having less effect on triglycerides and clotting factors — making it the preferred route when any of the following apply:

  • History of, or risk for, blood clots (VTE / DVT / PE)
  • Migraine with aura
  • Cardiovascular risk factors or elevated stroke risk
  • High triglycerides
  • Liver enzyme concerns or gallbladder disease
  • Smokers
  • Hypertension
  • Metabolic syndrome / insulin resistance
  • Obesity / high BMI
  • Starting hormones after age 60 or more than 10 years post-menopause
  • Preference for steady, stable hormone levels

Notes for Your Visit

This handout is educational and not a substitute for medical advice. Always review lab results, diagnoses, and treatment decisions with your healthcare provider.

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