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The Perimenopause Symptom Tracker scores the five most common perimenopause symptoms — hot flashes, sleep disruption, mood changes, menstrual cycle irregularity, and fatigue — each on a 0-5 severity scale, producing a 0–25 composite score. Categorized as Mild (under 6), Moderate (6–11), or Severe (12+). Perimenopause is the 4–8 year transition period before menopause, typically affecting women aged 40–55 with average age of menopause (12 months without period) at 51 in the US. During perimenopause, ovarian estrogen production fluctuates erratically rather than declining smoothly, causing the cluster of symptoms tracked here. About 80% of women experience at least mild symptoms; 20–30% experience symptoms severe enough to disrupt work, relationships, or quality of life. Symptoms typically peak in the 2 years before and 2 years after final menstrual period. The North American Menopause Society (NAMS) and American College of Obstetricians and Gynecologists (ACOG) endorse symptom tracking as part of clinical management — the score helps providers prioritize treatment intensity. The five tracked symptoms: (1) Hot flashes — sudden warmth, sweating, often with palpitations; affect 75–80% of women, can persist 7–10 years on average. (2) Sleep disruption — insomnia, night sweats, frequent waking; affects 40–60% of women. (3) Mood changes — irritability, depression, anxiety; affects 23% in clinical studies. (4) Cycle changes — irregular timing, skipped periods, heavy bleeding; affects most women in perimenopause. (5) Fatigue — beyond what sleep deprivation explains; affects 50%+ of women. Severity rating considers both frequency and impact: 0 = none, 1 = occasional and mild, 2 = weekly and tolerable, 3 = several times weekly and disruptive, 4 = daily and significantly impacting life, 5 = constant and severe. Treatment options span a wide spectrum based on severity: lifestyle changes (regular exercise, cooling techniques, stress management, sleep hygiene) effective for mild symptoms; non-hormonal medications (SSRIs/SNRIs, gabapentin, fezolinetant) for moderate cases or those who can't use hormones; hormone replacement therapy (HRT — estrogen + progesterone in patches, gels, or oral) for moderate-to-severe symptoms when no contraindications. HRT is the most effective treatment but underused in the US after Women's Health Initiative 2002 findings — subsequent re-analyses confirm HRT is safe and beneficial for most women started within 10 years of menopause. NAMS 2022 position statement strongly supports HRT for symptomatic women in this window.

1. 1Step 1 — Rate hot flashes / vasomotor symptoms on 0-5 severity scale
2. 2Step 2 — Rate sleep disruption (insomnia, night sweats, waking)
3. 3Step 3 — Rate mood changes (irritability, anxiety, low mood)
4. 4Step 4 — Rate menstrual cycle changes (skipped periods, heavy bleeding, irregular timing)
5. 5Step 5 — Rate fatigue (persistent tiredness beyond what sleep would explain)
6. 6Step 6 — Calculator sums ratings into 0–25 composite score
7. 7Step 7 — Assigns severity tier: Mild (<6), Moderate (6–11), or Severe (12+); track over time for trends