Help us prepare for your appointment by completing this form in advance.
This form includes the Greene Climacteric Scale - a validated questionnaire that maps your symptoms across psychological, physical, and vasomotor domains.
Completing it gives your doctor a detailed symptom profile before you even walk in, which means a much more productive consultation. It takes about 8 minutes.
For example: 6 months, 2 years, etc.
Describe changes in frequency and length of periods.
For example: 2 minutes, 5-10 minutes, etc.
For example: stress, caffeine, heat, certain foods, etc.
PHQ-9 screening question
PHQ-9 screening question
Include whether your partner understands, and any pain during intercourse.
Specify if it was you or a family member (mother, sister, etc.) and if possible, the type (ductal, lobular, etc.)
CRITICAL - Combined HRT may increase stroke risk if you have migraine with aura
Describe pattern (light, heavy, spotting, frequency) and any investigations done
For example: Normal, Osteopenia, Osteoporosis, and the year
For example: Estradot patch, Elleste Duet tablet, Oestrogel gel, etc.
For example: 2 years, 6 months, etc.
Include doses and frequency if you know them
Many women are prescribed antidepressants for what is actually perimenopause
1 unit = small glass of wine, half pint of beer, or single spirit
For example: 3 times per week, 30 minutes of brisk walking
Include amount and direction (gain/loss) and over what period
Anything you would like your doctor to know before your appointment.
Your information is sent securely to your doctor at LoveMyLife. We will not share your details with third parties. By submitting this form, you consent to LoveMyLife contacting you regarding your appointment.