Could I be going through menopause? Recognise your symptoms and prepare for your consultation
Could I be going through menopause? Recognise your symptoms and prepare for your consultation
Are your periods changing? Are you sleeping less well, feeling more irritable or finding it harder to concentrate? Perhaps you are also experiencing hot flushes or have less energy. You may be wondering: could this be the menopause transition?
At HAP.GENT, we take time to discuss your symptoms. You do not need to wait until your periods have stopped completely. Together, we explore what is changing, what other causes might be contributing and what could help you.
Changes often begin before your last period
During the menopause transition, ovarian function changes and hormone levels fluctuate. The phase around your final menstrual period is called perimenopause. It begins before your last period and continues until one year afterwards. You can therefore still have periods while experiencing menopause-related symptoms.
Menopause refers to your final menstrual period. It is identified retrospectively after twelve months without a period, provided there is no other explanation. Hormonal contraception can affect bleeding patterns and make this assessment more difficult.
Can blood tests help?
In otherwise healthy women aged 45 or over with typical menopause-related symptoms, the diagnosis is usually based on symptoms and menstrual patterns. Blood tests are generally unnecessary for this purpose.
Depending on your age, symptoms and medical history, your doctor may suggest targeted blood tests. These can help investigate other causes, such as anaemia or a thyroid disorder. An FSH test may be useful when early menopause is suspected.
Measurements of oestradiol, progesterone, LH and FSH do not constitute a routine confirmation test for menopause. Hormone levels can fluctuate considerably during perimenopause. A single blood sample may therefore not provide a reliable overall picture, and a normal result does not rule out menopause-related symptoms. Your doctor will assess which tests are useful in your situation, taking contraception or hormone treatment into account.
More than hot flushes
Every woman experiences the menopause transition differently. Possible symptoms include:
Hot flushes and night sweats.
Difficulty falling asleep or waking more often.
Irritability, anxiety or changes in mood.
Tiredness and reduced energy.
Memory and concentration difficulties, sometimes called brain fog.
Muscle and joint discomfort.
Vaginal dryness or discomfort during sex.
Changes in sexual desire or bladder symptoms.
These symptoms are not all specific to menopause. We therefore also consider your general health, medication, sleep and personal circumstances.
Two questionnaires to help you prepare
It is not always easy to describe every symptom during a consultation. A questionnaire can help you take time beforehand to reflect on what you are experiencing.
Below you will find the Menopause Rating Scale (MRS) and an adapted Meno-D working questionnaire. You can copy the questionnaires directly from this page, add your answers and bring them to your appointment.
The MRS covers general menopause-related symptoms. Meno-D focuses on mood and related symptoms and was originally developed to assess depressive symptoms during perimenopause.
The Meno-D version below is an English rendering of our adapted, non-validated Dutch working version. It is not the original validated English questionnaire. The additional interview questions have been summarised. This version supports discussion with your doctor and is not a diagnostic test. There is no validated score threshold for diagnosing depression using this adapted version.
Your experience matters more than a score
A score helps describe symptoms. It does not determine your stage of menopause, prove that symptoms have a hormonal cause or automatically establish which treatment you need.
At HAP.GENT, your personal experience remains central: what is troubling you, what have you already tried and what would you like to improve?
Finding an approach that suits you
Depending on your symptoms, we may discuss sleep and lifestyle advice, targeted treatment for vaginal symptoms, hormone therapy or other treatments. We weigh the potential benefits and risks in the context of your medical history and preferences.
Persistent low mood or anxiety also deserves a separate assessment. We do not automatically attribute these symptoms to menopause.
Heavy or unusual vaginal bleeding should be assessed. Any bleeding after twelve months without a period also requires an appointment with your GP.
Prepare for your consultation
If possible, complete the questionnaires below and bring your answers on paper or on your phone. Also note when your last period occurred, how your menstrual pattern has changed and which medication, contraception or hormone treatment you use.
Completing the questionnaires is optional. You are welcome to attend without them. You can leave questions unanswered if you find them difficult and discuss them during your consultation.
If you have thoughts of self-harm or suicide, do not wait for your scheduled appointment. Seek help immediately from your GP or the out-of-hours GP service. Call 112 if there is immediate danger.
Questionnaire 1 — Menopause Rating Scale (MRS)
Name:
Date:
How severe are the following symptoms at present? Enter one score for each item:
0 = none · 1 = mild · 2 = moderate · 3 = severe · 4 = very severe
The wording below has been translated from the Dutch version accompanying this article.
Hot flushes and sweating
Episodes of sweating.
My score: …
Heart discomfort
Being more aware of your heartbeat than usual, skipped beats, a racing heartbeat or a feeling of tightness.
My score: …
Sleep problems
Difficulty falling asleep, difficulty staying asleep or waking early.
My score: …
Depressed mood
Feeling down or sad, close to tears, lacking interest or experiencing mood swings.
My score: …
Irritability
Feeling nervous, inner tension or feeling aggressive.
My score: …
Anxiety
Inner restlessness or feelings of panic.
My score: …
Physical and mental exhaustion
Generally functioning less well, poorer memory, reduced concentration or forgetfulness.
My score: …
Sexual problems
Changes in sexual desire, sexual activity or satisfaction.
My score: …
Bladder problems
Difficulty urinating, needing to urinate more often or involuntary urine leakage.
My score: …
Vaginal dryness
A dry or burning sensation in the vagina or difficulty with sexual intercourse.
My score: …
Joint and muscle symptoms
Joint pain or rheumatic symptoms.
My score: …
Total score, if all items are completed: … / 44
Which symptoms trouble me most?
…
This score describes your symptom burden. It does not determine the cause of your symptoms or your stage of menopause.
Translated from the Dutch wording included in the NVAB guideline, Overgang en Werk (2026).
Questionnaire 2 — Meno-D: adapted working version
Name:
Date:
This is an English rendering of an adapted, non-validated Dutch working version. It is not the original validated English Meno-D questionnaire. The twelve scoring items and response descriptions have been translated; the additional interview questions have been summarised.
Consider the past two weeks. Choose one score from 0 to 4 for each item. Where relevant, compare your current experience with how you felt before the menopause transition. You do not need to interpret your score yourself: we will discuss your answers during your consultation.
A. Energy
How has your energy been over the past two weeks?
0: No change in energy; I feel active throughout the day.
1: More tired after activity than before.
2: Less active because of tiredness.
3: Usually tired despite resting; less active.
4: Constantly exhausted; even small tasks such as brushing my hair require considerable energy.
My score: …
B. Suspicious thoughts
Over the past two weeks, have you worried that others think badly of you?
0: No suspicious thoughts.
1: Increasingly concerned that others think badly of me.
2: Suspecting that people at work or at home think badly of me.
3: Convinced that others have a low opinion of me and are trying to replace me.
4: Convinced that others are actively making plans to harm me in different ways.
My score: …
C. Irritability
Over the past two weeks, have you been more irritable than usual?
0: No irritability.
1: Mild irritability.
2: Stronger irritable reactions to minor events.
3: Anger, snapping or verbal outbursts in response to minor events.
4: Rage and major verbal outbursts in response to minor events.
My score: …
D. Self-esteem
How have you felt about yourself over the past two weeks?
0: Good self-esteem or no change.
1: A slight reduction in self-esteem.
2: Low self-esteem without a factual basis.
3: Very low self-esteem across all areas of life, with strongly negative comments about myself.
4: No sense of self-worth; believing that the world would be better off without me.
My score: …
If you have thoughts of self-harm or suicide, seek help immediately, regardless of your score. Do not wait for your scheduled consultation. Call 112 if there is immediate danger.
E. Isolation
How have your social interactions been over the past two weeks?
0: Normal social interactions.
1: Fewer social interactions.
2: No interest in social interactions.
3: Withdrawing from social interactions and work.
4: Feeling isolated, as though I am in a bubble, even when with other people.
My score: …
F. Anxiety
Have you experienced more anxiety over the past two weeks?
0: No new anxiety symptoms.
1: More anxiety about performing or functioning in public.
2: Considerable anxiety when undertaking new tasks.
3: More anxiety when undertaking ordinary, familiar tasks.
4: Panic attacks and considerable anxiety when undertaking ordinary, familiar tasks.
My score: …
G. Physical symptoms
Have you experienced physical pain over the past two weeks?
0: No physical symptoms.
1: More muscle and joint pain with exertion.
2: More pain in the legs, back and joints with minor exertion.
3: Frequent headaches, muscle and joint pain that limit activities.
4: Severe pain requiring pain relief and preventing activities.
My score: …
H. Sleep
How have you slept over the past two weeks?
0: No sleep problems.
1: Waking briefly once or twice a night, but easily falling asleep again.
2: Waking several times a night, but easily falling asleep again.
3: Waking three or more times a night because of hot flushes and sweating, with difficulty falling asleep again.
4: Consistently sleeping for two hours or less per night; sweating, hot flushes and alternating feelings of heat and cold disturb sleep throughout the night.
My score: …
I. Weight
Have you noticed changes in your weight over the past two weeks?
0: No weight change.
1: Slight weight gain of 1–2 kg.
2: Moderate weight gain of 3–6 kg despite unchanged diet and exercise.
3: Continuing weight gain and increased abdominal fat despite eating less and exercising more.
4: Major weight gain of more than 6 kg, with increased fat around the abdomen, breasts, hips and thighs.
My score: …
J. Sexual desire
Has your sexual desire changed over the past two weeks?
0: No change in sexual desire.
1: A slight reduction in sexual desire.
2: Reduced sexual desire.
3: Reduced sexual desire and discomfort during sexual activity.
4: Complete loss of interest in sexual activity.
My score: …
K. Memory
Have you noticed changes in your memory over the past two weeks?
0: No change in memory.
1: Slight difficulty remembering names and numbers.
2: Needing lists to function at home or at work.
3: Memory problems that interfere with functioning.
4: Severe memory loss that makes functioning impossible.
My score: …
L. Concentration
Have you had difficulty concentrating over the past two weeks?
0: No change in concentration.
1: Mild difficulty concentrating when reading.
2: Mild difficulty concentrating when reading and watching television or films.
3: Marked difficulty concentrating when reading and watching television or films.
4: Unable to concentrate on any task.
My score: …
Total score, if all items are completed: … / 48
What would I particularly like to discuss with my GP?
…
There is no validated diagnostic cut-off for this adapted working version. A score does not establish a diagnosis or demonstrate a hormonal cause.
Source: Kulkarni J, Gavrilidis E, Hudaib AR, Bleeker C, Worsley R, Gurvich C. Development and validation of a new rating scale for perimenopausal depression—the Meno-D. Translational Psychiatry 8, 123 (2018), Table 1. © The Author(s) 2018, CC BY 4.0. This English text was translated from the Dutch working translation and summarised interview questions prepared with ChatGPT for HAP.GENT. This adapted version has not been approved or validated by the original authors.
Dr Didier Hebberecht — HAP.GENT
Sources
NICE — Menopause: identification and management
NVAB — Overgang en Werk guideline, including the Dutch MRS