Menopause Symptom Diary: What to Track and for How Long

In perimenopause, symptoms shift from week to week. Hot flashes come on some days, bad nights on others, and periods arrive early and then late. A notebook keeps all of that in order. So does Sam: the symptom diary for symptoms and cycle tracking for bleeding days, with sleep and resting heart rate from Apple Health in the same app.

The WHO says menopause is not a disease but a natural part of biological aging. A diary does not tell you whether you have reached it, and it does not ease symptoms by itself. What it gives your GP or gynecologist is dates and numbers instead of a vague memory of bad weeks.

When do perimenopause symptoms start?

Often years before the last period. ACOG is the US college of obstetricians and gynecologists. It says the amount of estrogen the ovaries make starts to fluctuate in your 30s and 40s. The NIA says most women begin the menopausal transition between 45 and 55.

One of the first signs is usually a change to your periods, the NHS says. They may come more or less often, and bleeding may get heavier or lighter. Menopause itself is the point when you have not had a period for 12 months. ACOG gives 51 as the average age; the NIA gives 52 for the United States.

The NHS adds that symptoms usually last 7 to 9 years, sometimes longer, and can change along the way. Hot flushes (the UK word for hot flashes) may fade while low mood or anxiety take their place. A pattern that shifts over years is easy to lose in memory. That is the case for writing it down.

What belongs in a menopause symptom diary?

The symptoms you actually have. The NHS and the WHO name hot flushes and night sweats, sleep problems and mood changes. The NHS also lists brain fog, aches, headaches, vaginal dryness, bladder problems and palpitations, among others. The NHS notes that some people hardly have any, so pick the ones that affect you.

A short daily list is enough:

• Hot flashes and night sweats: yes or no, how strong, roughly how many, day or night.
• Sleep: trouble falling asleep, waking in the night, how rested you feel in the morning.
• Mood: low mood, anxiety or irritability, on the same scale each day, for example 0 to 10.
• Periods: which days you bled, how heavily, any spotting.
• Other symptoms you have: joint pain, headaches, brain fog, vaginal dryness, leaking urine.
• Medicines: anything new, stopped or changed, including contraception.

ACOG's printable menopause symptom tracker is built in a similar way. For each group it asks when the symptoms started and whether they are getting worse or staying the same. For hot flashes it asks how many you have a day and how long they last. The Menopause Society suggests noting how often symptoms come and at what time of day.

Contraception belongs on the list for a reason. The NHS notes that hormonal contraception can make it harder to tell whether you have reached perimenopause or menopause.

If you have low mood for most of the day, every day, for more than two weeks, see your GP or doctor; you do not need to wait for a planned appointment. If you have thoughts of not wanting to live, call your local emergency number or a crisis line. Samaritans answer on 116 123 in the UK and Ireland; in the US, call or text 988. Both are free and open day and night.

What every symptom diary needs, and when paper is enough, is covered in Symptom diary: paper template or app?

How long should you keep a menopause symptom diary?

There is no fixed rule. NICE is the guideline body for England. It says symptoms can range from minor to severe and can last for short or long periods. Perimenopause rarely follows a neat monthly rhythm, so a few months of entries can show more than a single week.

For symptoms that come rarely, keep going longer. Ask your practice beforehand which period they want to see. And keep each day short, so you are still writing in month three. You do not need a finished diary to see your doctor: book when symptoms bother you and keep the diary going alongside.

What does your doctor need from the diary?

A summary, not every page. Before the appointment, pull out:

• The period you covered, for example eight weeks.
• On how many days each main symptom came, and how many of those were severe.
• Your bleeding days and the gaps between periods.
• What limits you most at home or at work.
• All your medicines, including vitamins and supplements.

An example with invented numbers: "Eight weeks of notes. Hot flashes on 38 of 56 days, 9 of them severe, mostly at night. Woke in the night on 25 days. Periods came 24, 41 and 19 days apart. Low mood on 6 days." That takes half a minute to say.

The NHS suggests noting when each symptom started and what makes it better or worse. It also suggests writing down your two or three most important questions. For who to see and how referrals work in the UK and the US, read Which doctor for menopause. What Sam keeps through menopause, and what it does not, is in the menopause overview.

In Sam, you create the monthly report for the previous month yourself, from the 1st. It needs notifications, Apple Health access and an answer about chronic conditions. From the second report on, you also need your daily status (good, a bit off or sick) on at least 15 of the last 30 days. Symptom entries do not count toward that.

Can a diary tell you whether it is perimenopause?

No. It records what you go through; it does not confirm anything. NICE recommends that in otherwise healthy women aged 45 or over, doctors identify perimenopause without lab tests. The signs are hot flushes and sweats that have recently started, plus any change in the cycle. NICE advises against hormone and scan-based tests for this at that age.

Between 40 and 45, NICE says a doctor may consider an FSH blood test if symptoms include a change in periods. The same goes for women under 40 in whom menopause is suspected. Whether that applies to you is for your doctor to decide. More in Menopause blood test: what FSH levels can tell you.

So from 45, if you are otherwise healthy, your symptoms and your periods are usually what the assessment rests on. Your notes are that information, in order.

A diary is not a treatment, though. It does not ease hot flashes or improve sleep. ACOG says tracking symptoms makes it easier to talk with your ob-gyn about your concerns and agree a plan.

Which symptoms need a check, not only a diary entry?

Bleeding comes first. The NHS says to contact your GP if your bleeding pattern has changed and you bleed more than before. The same goes for any vaginal bleeding after 12 months without a period. That includes a single episode, spotting, or pink or brown discharge. Get it checked soon. The NIA adds bleeding or spotting after sex or between periods. It also names periods very close together and periods lasting more than a week.

If you take hormones, ask your doctor which bleeding to expect.

Palpitations need a check before they are put down to menopause. The NHS lists a fast heartbeat as a reason to contact your GP. More on this in Menopause: palpitations, anxiety and blood pressure.

If palpitations do not go away, or come with chest pain, shortness of breath, feeling faint or fainting, call your local emergency number (112 in the EU, 999 in the UK, 911 in the US). Do not wait for it to pass.

Keep your menopause symptoms in Sam and bring the monthly report

You go into the appointment with weeks of entries instead of an estimate. From the 1st, you can create the monthly report for the previous month as a PDF: your symptom days in a calendar and your five most frequent symptoms.

• Instead of a notebook: you log hot flashes, night sweats or fatigue with a severity. Sleep problems and mood changes count as present. Each entry keeps its date.
• Instead of two apps: sleep and resting heart rate from Apple Health sit in the same app. You only enter what you know yourself.
• Instead of loose notes on your periods: cycle tracking keeps bleeding days, flow, spotting and how the bleeding affected your day.

Sam keeps one entry per symptom per day, with no count or time, and does not say whether you are in perimenopause. More: menopause overview.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• Which doctor for menopause: GP, gynecologist or specialist
• Menopause: palpitations, anxiety and blood pressure
• Symptom diary: paper template or app?
• Migraine in the menopause: log the change
• Menopause blood test: what FSH levels can tell you
• Apple Watch and perimenopause
• Insomnia in menopause: what to note

Sources

Updated: October 2026

• NHS: Symptoms of menopause and perimenopause (page last reviewed 19 May 2026)
• NHS: Symptoms of depression in adults (page last reviewed 5 July 2023)
• NHS: What to ask your doctor or other healthcare professional (page last reviewed 12 January 2023) and Heart palpitations (page last reviewed 17 March 2026)
• NICE: Menopause: identification and management (NG23), recommendations 1.2.2 and 1.3.1 to 1.3.6 (published 12 November 2015, last updated 15 April 2026)
• WHO: Menopause, fact sheet (16 October 2024)
• National Institute on Aging: What Is Menopause? (content reviewed 16 October 2024)
• ACOG: The Menopause Years (last reviewed December 2025) and Menopause Symptom Tracker (last reviewed December 2025)
• The Menopause Society: Are You Asking the Right Questions to Make the Most of Your Menopause Healthcare Visit? (press release, 6 February 2024)
• Samaritans: Contact us and 988 Suicide & Crisis Lifeline: 988lifeline.org