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Female
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Male
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Have you been diagnosed with Menopause?
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If yes, what year?
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Have you had a hysterectomy?
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If yes, when?
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If yes, do you still have your ovaries?
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if yes to above section skip to symptoms list.
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Do you still get a menstrual period?
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When was your last Menstrual period?
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Do you experience irregular periods?
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if yes, how often? ( how many months between?)
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Does your menstrual cycles that last over 7 days or more often than every 21 days?
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please rate the following symptoms 0-10 (0 is none and 10 is the worst)
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Hot flash/ sweating during the day
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Hot flashes / sweating during the night
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Fatigue in the morning
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Fatigue in the evening
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Irritability
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Anxiety
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mood swings
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memory loss
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Vaginal dryness
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Breast tenderness
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Insomnia
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Decreased libido
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weight gain
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Dry skin
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Hair loss
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increased facial or body hair
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Sleeplessness
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Unusual tiredness / Fatigue
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Acne / pimples
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Loss of pubic hair
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Increased appetite / weight gain
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difficulty attaining / Decreased erections
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Decreased muscle size
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New Short Text Field
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