Symptom tracker

Give your doctor the full picture.

Print it, fill it in each evening for two weeks, and bring it to your appointment. 1 = barely noticeable, 5 = severe.

It’s paper. Nothing you write here is sent to us. A digital version is on the way.

Meet Midlife · Two-week tracker

Name ____________Start date ________Age ____Last period ________

Symptom

Period / bleeding (none, light, heavy)

Hot flashes (# per day)

Night sweats (# per night)

Hours slept

Times woke up

Mood (1–5)

Anxiety / irritability (1–5)

Brain fog (1–5)

Joint or muscle aches (1–5)

Headache (Y/N)

Vaginal dryness / discomfort (1–5)

Urinary changes (Y/N)

Energy (1–5)

Notes / triggers

Questions for my clinician

A note-taking tool, not a diagnostic test. Patterns you notice are for discussion, not diagnosis.