PRINTABLE
Printable menopause symptom diary: 4 weeks on one sheet
Editorially reviewed on October 29, 2026Medical review: pending
Quick answer
This free A4 diary lets you rate your main symptoms from 0 to 3 each day for four weeks, note your period, sleep and anything you took, then bring it to your doctor. A month of notes shows a pattern far better than "basta, pagod lang ako lagi". Print it, stick it on the ref, and fill it in at night.
Why a paper diary helps at the OB
Consults are short. When you are asked "kumusta ka?", it is easy to forget the 3 am waking, the rage, or that your period skipped two months. A diary does the remembering for you.
It also helps you be believed. Filipinas on Reddit describe being told it is "just stress" or being given a pain reliever and sent home (r/AskPinay). A written record of four weeks of night sweats and missed sleep is harder to brush aside. Doctors usually diagnose perimenopause from your age, your cycle changes and your symptoms, not from a blood test, so this sheet is real clinical information (NICE NG23 summary).
How to use it
- Print on A4. Fill one row per day, ideally before bed.
- Score each symptom: 0 none, 1 mild, 2 bothers me, 3 severe or stops me doing things.
- Mark your period: S spotting, L light, N normal, H heavy, F flooding.
- Write hours slept and how many times you woke.
- Note medicines and supplements in the last column.
- At the end of four weeks, circle your three worst symptoms. Those are what you open the consult with.
Prefer your phone? The online symptom diary does the same thing, keeps the data only on your device, and builds a Health Report for you.
See a doctor soon, do not wait for week 4
Stop and see a doctor promptly if you have any bleeding after 12 months with no period, a new breast lump, chest pain, sudden severe headache, one leg that is swollen and painful, or thoughts of harming yourself. Read bleeding after menopause.
Printable: My symptom diary
Name (optional): ____________ Month: ____________ Age: ____
Scores: 0 none, 1 mild, 2 bothers me, 3 severe. Period: S spotting, L light, N normal, H heavy, F flooding.
| Day | Hot flashes | Night sweats | Sleep problems | Mood or irritability | Anxiety | Brain fog | Joint or muscle pain | Palpitations | Headache | Vaginal dryness | Bladder | Period | Hours slept | Times woke | Medicines or supplements |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | |||||||||||||||
| 2 | |||||||||||||||
| 3 | |||||||||||||||
| 4 | |||||||||||||||
| 5 | |||||||||||||||
| 6 | |||||||||||||||
| 7 |
Repeat the 7-row block for weeks 2, 3 and 4 (days 8 to 28).
Other symptoms I noticed (itchy ears or skin, hair thinning, sweat smells different, weight around the belly, low libido, frozen shoulder): ________________________________
My three worst symptoms this month:
- ____________ 2. ____________ 3. ____________
How they affected work, family or sleep: ________________________________
What I want to ask my doctor: ________________________________
Frequently asked questions
How long should I keep a symptom diary before seeing my OB?
Four weeks is ideal because it covers about one cycle. But do not delay a consult just to finish it, and never wait if you have a red-flag symptom.
Do I need a blood test to know if I am in perimenopause?
Usually not if you are over 45 with typical symptoms. NICE NG23 advises diagnosing without lab tests in that group. See FSH test.
Can I use this diary in Tagalog?
Yes. Write in whatever language is easiest. The online diary also has a Taglish toggle.
Is there a digital version?
Yes, the free symptom diary tool. Your entries stay on your device only.
Keep reading
Sources
This guide is for information. Talk to a doctor before starting, stopping or changing any treatment.