Monthly Symptom Tracking Chart

Please note: this chart is designed for access from a desktop computer. It can also be printed and filled-in by hand. Mark off your symptoms daily to help you — and your doctor — keep track of your body. Rank symptoms on a scale of 1 (present, but not bad), 2 (fair), 3 (bad) and 4 (unbearable!).

Month __________________ Year __________
Day of the Month
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Physical Symptoms
Irregular periods
Hot flashes
Night sweats
Vaginal dryness
Bladder control problems
Insomnia/sleep disruptions
Palpitations
Skin changes
Headaches
Breast Tenderness
Upset stomach, nausea
Tingling/itchy skin
“Buzzing” in your head
Bloating
Dizziness, lightheadeness
Sore joints or muscles
Hair loss or thinning
Increase in facial hair
Changes in body odor
Dry mouth
Emotional Signs
Irritability
Mood
swings
Lowered
libido
Anxiety
“Brain
fog”
Memory
lapses
Fatigue;
low energy
Poor
concentration
Emotional
detachment
Month __________________ Year __________
Day of the Month
16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Physical Symptoms
Irregular periods
Hot flashes
Night sweats
Vaginal dryness
Bladder control problems
Insomnia/sleep disruptions
Palpitations
Skin changes
Headaches
Breast Tenderness
Upset stomach, nausea
Tingling/itchy skin
“Buzzing” in your head
Bloating
Dizziness, lightheadeness
Sore joints or muscles
Hair loss or thinning
Increase in facial hair
Changes in body odor
Dry mouth
Emotional Signs
Irritability
Mood
swings
Lowered
libido
Anxiety
“Brain
fog”
Memory
lapses
Fatigue;
low energy
Poor
concentration
Emotional
detachment