PeriPrintable perimenopause symptom diary
Pick the symptoms that matter to you and print a grid for 7, 14 or 28 days. Each symptom is rated 1 to 5, with rows for sleep, bleeding and medicines.
This tool runs in your browser. Nothing you choose or type is saved, sent or tracked. Print it, or choose “Save as PDF” in the print dialog, before you close the page.
Preview
Symptom diary
Dates: ____________________
Rate each symptom 1–5: 1 barely noticed · 2 noticeable · 3 got in the way · 4 hard to get through the day · 5 stopped me doing something. Leave blank if you didn’t have it. Bleeding: S spotting, L light, N normal, H heavy.
| Day | Day 1 __/__ | Day 2 __/__ | Day 3 __/__ | Day 4 __/__ | Day 5 __/__ | Day 6 __/__ | Day 7 __/__ | Day 8 __/__ | Day 9 __/__ | Day 10 __/__ | Day 11 __/__ | Day 12 __/__ | Day 13 __/__ | Day 14 __/__ |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hot flashes | ||||||||||||||
| Night sweats | ||||||||||||||
| Insomnia | ||||||||||||||
| Brain fog | ||||||||||||||
| Anxiety | ||||||||||||||
| Mood swings | ||||||||||||||
| Joint pain | ||||||||||||||
| Fatigue | ||||||||||||||
| Mood (1–5, 5 = good) | ||||||||||||||
| Energy (1–5) | ||||||||||||||
| Stress (1–5) | ||||||||||||||
| Sleep (hours) | ||||||||||||||
| Bleeding (S / L / N / H) | ||||||||||||||
| HRT / medicines taken (✓) |
Notes: what helped, what made it worse, what you missed
Printable from peridaily.com. For your own records; general information, not medical advice.
Want to see one filled in? Look at the sample diary made from fictional data. Not sure what to write? Read how to keep a symptom diary.
From paper to Peri
The Peri app uses the same 1 to 5 scale and the same symptom names, so you can switch to your phone without starting over. It adds up days and averages for you and can export them for your appointment.
