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The Menopause Spreadsheet

The Menopause Spreadsheet

One visit-ready page. Your cycle stage, your symptom scores, your hot flash burden, your sleep, what it is costing you — and the tests that are, and are not, indicated.

The best advice going around about menopause appointments is disarmingly simple: bring a spreadsheet. Women who arrive with dates, counts, and scores get taken seriously. Women who arrive saying "I've been feeling off" get fifteen minutes and a shrug.

The problem is that building the spreadsheet is work — and most women don't know which columns matter. This tool builds it for you. Answer the questions once, and it produces a single page you can print, copy into an email, or download as an actual spreadsheet file.

Nothing you enter leaves your device. There is no account, no server, no storage. Everything is calculated in your browser and disappears when you close the tab — so print, copy, or download before you leave.

What it puts on the page

  • Where you are in the transition — staged by cycle pattern using the STRAW+10 criteria, the international standard.1
  • A symptom score across eleven symptoms in three groups, with the published severity bands.2
  • Your hot flash count, graded the way drug trials grade it — so your numbers can be compared to the numbers in the studies.3
  • A sleep score, because "I'm tired" gets dismissed and a number does not.4
  • What it is costing you — work days, hours cut, relationships. This is often the most persuasive row on the sheet.
  • Red flags that need evaluation on their own, separate from menopause.7,8
  • Which blood tests apply to you — and which ones you should decline.5

This tool organizes information. It does not diagnose, and it does not replace an evaluation by your clinician.

Evidence & Sources

Every threshold, band, and staging rule in this tool traces to one of the publications below.

  1. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, et al. Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159–68. doi:10.1210/jc.2011-3362 Supplies the staging logic: a persistent difference of 7 days or more between consecutive cycles marks the early transition (stage −2); an interval of 60 days or more without a period marks the late transition (stage −1); 12 months without a period marks postmenopause (stage +1).
  2. Heinemann K, Ruebig A, Potthoff P, Schneider HPG, Strelow F, Heinemann LAJ, et al. The Menopause Rating Scale (MRS) scale: a methodological review. Health Qual Life Outcomes. 2004;2:45. doi:10.1186/1477-7525-2-45 Supplies the eleven symptom domains, the three subscales (somato-vegetative 0–16, psychological 0–16, urogenital 0–12), the 0–44 total, and the severity bands: 0–4 none or little, 5–8 mild, 9–16 moderate, 17 or above severe.
  3. US Food and Drug Administration. Guidance for industry: estrogen and estrogen/progestin drug products to treat vasomotor symptoms and vulvar and vaginal atrophy symptoms — recommendations for clinical evaluation. Rockville (MD): FDA; 2003. Supplies the hot flash grading (moderate: heat with sweating, activity continues; severe: heat with sweating, activity stops) and the trial entry benchmark of 7–8 moderate-to-severe flashes per day, or 50–60 per week.
  4. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307. doi:10.1016/S1389-9457(00)00065-4 Supplies the seven sleep domains and the 0–28 bands: 0–7 no clinically significant insomnia, 8–14 subthreshold, 15–21 moderate clinical insomnia, 22–28 severe.
  5. National Institute for Health and Care Excellence. Menopause: identification and management. NICE guideline NG23. London: NICE; 2015 (updated 2024). Supplies the testing rules: no laboratory tests to identify perimenopause or menopause at age 45 or over with typical symptoms; anti-Müllerian hormone, inhibin, estradiol, antral follicle count and ovarian volume are not to be used for this purpose; FSH only at ages 40–45 with symptoms and cycle change, or under 40 where menopause is suspected; FSH is uninterpretable on combined hormonal contraception or high-dose progestogen. Other tests may still be needed if a non-menopausal cause is suspected.
  6. Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531–9. doi:10.1001/jamainternmed.2014.8063 SWAN cohort, 1,449 women with frequent vasomotor symptoms: median total duration 7.4 years, persisting a median of 4.5 years beyond the final menstrual period. Used for the duration context line only.
  7. American College of Obstetricians and Gynecologists. Updated guidance regarding the role of transvaginal ultrasonography in evaluating the endometrium of individuals with postmenopausal bleeding. Clinical Practice Update. Obstet Gynecol. 2026 Apr 16 [Epub ahead of print]. doi:10.1097/AOG.0000000000006275 The current standard for postmenopausal bleeding: transvaginal ultrasonography and endometrial tissue sampling together for most patients at initial evaluation. Ultrasound alone may miss 5–12% of cancers. Replaces the prior thin-stripe triage for most patients.
  8. American College of Obstetricians and Gynecologists. The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Committee Opinion No. 734. Obstet Gynecol. 2018;131(5):e124–9. doi:10.1097/AOG.0000000000002631 Context for reference 7, and the source of the underlying fact: vaginal bleeding is the presenting sign in more than 90% of postmenopausal women with endometrial carcinoma.
  9. ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstet Gynecol. 2014;123(1):202–16 (reaffirmed 2024). doi:10.1097/01.AOG.0000441353.20693.78 US guidance on the treatment conversation this sheet is designed to open.
  10. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–94. doi:10.1097/GME.0000000000002028 Basis for the history checklist: the benefit–risk balance is individualized by age, time since menopause, and personal risk factors — which is why those items belong on the sheet rather than being pre-judged by a calculator.
On the two scored instruments. The symptom grid follows the domains, 0–4 anchors and published severity bands of the Menopause Rating Scale, and the sleep section follows those of the Insomnia Severity Index. Both are worded here in plain English rather than reproduced verbatim, so treat the totals as close approximations of those instruments — good enough to track change over time and to show your clinician, not a licensed administration of either scale.

Build your sheet

Answer what you can. Leave anything blank that doesn't apply — the sheet will simply omit it.

1 · About you

2 · Your cycle — the staging questions

These four answers place you on the international staging system. They are the questions most likely to be skipped in a short appointment.

Best guess is fine. This single date does more work in the appointment than any blood test.
Stage from your cycle pattern—

3 · Symptom grid

Rate each over the past four weeks: 0 none, 1 mild, 2 moderate, 3 severe, 4 very severe.

Physicalsubtotal 0 / 16
Hot flashes, flushing, sweatingSudden heat, day or night
Heart discomfortRacing, skipping, pounding, tightness in the chest
Sleep problemsTrouble falling asleep, waking through the night, waking too early
Joint and muscle achesStiffness, pain, new aches without injury
Mood & mindsubtotal 0 / 16
Low moodSadness, tearfulness, loss of interest, feeling flat
IrritabilityShort fuse, rage that feels out of proportion, tension
AnxietyInner restlessness, panic, dread
Exhaustion — physical and mentalLow energy, brain fog, losing words, poor concentration
Genital & urinarysubtotal 0 / 12
Sexual problemsChange in desire, arousal, or satisfaction
Bladder problemsUrgency, going often, leaking, repeated infections
Vaginal drynessDryness, burning, pain with sex
Total symptom score0 / 44   —

4 · Hot flashes and night sweats

Count over a typical recent day. Moderate = heat with sweating, you keep going. Severe = heat with sweating, you have to stop what you're doing.

Moderate-to-severe flashes per week—   —

5 · Sleep — the past two weeks

Difficulty falling asleep0 none → 4 very severe
Difficulty staying asleep0 none → 4 very severe
Waking too early and not getting back to sleep0 none → 4 very severe
How dissatisfied are you with your current sleep?0 not at all → 4 very much
How noticeable to others is the effect on your quality of life?0 not at all → 4 very much
How worried or distressed are you about your sleep?0 not at all → 4 very much
How much does it interfere with your daily functioning?0 not at all → 4 very much
Sleep score0 / 28   —

6 · What it is costing you

These rows change appointments. A symptom score is abstract; eleven lost work days is not.

7 · What you have already tried

8 · History your clinician needs before discussing treatment

None of these settles anything by itself. They shape the conversation, and having them written down stops the appointment stalling while you try to remember dates.

If you tick this, the sheet will put it at the top — it should be the first thing discussed, not the last.

9 · Your three questions

Appointments run out of time. Written questions get answered; remembered ones don't.

Your Menopause Spreadsheet

The sheet

WhatYour answerReference point
Take this with you. Print it, copy it into a patient-portal message before the visit, or download the CSV and keep it as a running record — the second and third columns are far more persuasive when you can show the trend over six months.

Next, from the same library

Perimenopause Stage FinderWhere you are in the transition, in more detail Menopause CheckSymptom-based staging and assessment Menopause Treatment GuideWhat the evidence supports, option by option Hormone Therapy AidWorking through the risk–benefit conversation Bladder Leakage ToolIf the urinary row scored high Are My Periods Normal?If bleeding is the main problem 100 Questions: MenopauseAnswers to what the appointment didn't cover All menopause toolsThe full category on tools.obmd.com