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Perimenopause symptom tracker, printable and fillable

The Pivot Kit turns change over time into a record you can bring to a visit.

Perimenopause is the transition leading up to menopause. Symptoms can shift from week to week, which makes them hard to describe in a short visit. This kit gives you six tools to log them and one page to hand over. It organizes information to discuss with a clinician. It does not diagnose anything or recommend treatment.

$18.00Digital download. Fillable PDF. 10 pages.
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  • Fillable PDF: type into 532 fields
  • Print-only version with no form fields included, for handwriting
  • US Letter and A4, four files in the download
  • Designed for Adobe Acrobat Reader. Fields verified to fill in Chrome's PDF viewer
Cover page of The Pivot Kit, the perimenopause kit, with the line Change over time deserves a record. Weekly grid page from The Pivot Kit with boxes for daily counts and ratings.
The cover and a tracking page from The Pivot Kit.

What is inside

Six tools and provider scripts across 10 pages, with a contents page and a closing page.

  1. Symptom timelineTwelve months on one grid: 13 symptoms plus two write-in rows, rated once a month.
  2. Cycle length logTwelve periods with start date, cycle length, bleeding days, flow and notes.
  3. Vasomotor trackerFour weeks of daily hot flash and night sweat counts, with a severity rating and triggers.
  4. Cognition and sleep logFour weeks of sleep hours, wake-ups and brain fog ratings, with concentration notes.
  5. HRT decision memoQuestions to ask, options discussed and what you decided. It organizes the conversation and does not recommend any treatment.
  6. Provider visit summaryOne page to hand over: what changed and when, and what you are asking for.
  7. Provider scriptsThree lines to read when you hear “you’re too young” or “let’s try an SSRI first.”

Look at the pages

Twelve-month symptom timeline page from The Pivot Kit, a grid for rating each symptom by month. Provider scripts page from The Pivot Kit with three lines to read at an appointment. Closing page from The Pivot Kit pointing to the next receipt.

Perimenopause doctor appointment prep

A simple order of work for the weeks around a visit.

Pin graphic: A symptom tracker for the whole decade. The Pivot Kit pages on a cream background.
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  1. Track for four weeks.Use the vasomotor tracker for hot flashes and night sweats, and the cognition and sleep log for sleep and brain fog.
  2. Build the timeline.Fill in the twelve-month symptom timeline and the cycle length log, so you can say when changes began and how your cycles have shifted.
  3. Write your questions.Use the HRT decision memo to list what you want to discuss, including options you want to ask about.
  4. Bring the pages.Fill in the one-page provider visit summary, then print the pages or open the PDF. Read a script line if you need to.
  5. Record the visit.Use the free Appointment Receipt to note what was said, what was ordered or declined, and the next step.

Questions about the kit

Is this a perimenopause diagnosis tool?

No. The kit helps you organize what you notice and what you want to ask. Only a clinician can evaluate symptoms or diagnose a condition.

Can I fill it in on my phone or tablet?

The Pivot Kit is designed for Adobe Acrobat Reader, and the fields are verified to fill in Chrome's built-in PDF viewer. We have not tested phone or tablet apps, so we do not promise they will work. GoodNotes and Notability do not fill PDF form fields. To write on a tablet or on paper, use the print-only version, which has no form fields.

What do I get?

One download with four PDF files: Fillable US Letter, Fillable A4, Print US Letter and Print A4. Each has 10 pages. The fillable files have 532 fields. The print files have none.

Is there a free sample?

Yes. The one-page Appointment Receipt is free to print.

Bring the whole pattern to your next appointment.

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Looking for a different condition? See all the kits.