| Low Estrogen - female |  | 
| Hot flashes |  | 
| Hot Flashes Day time_________# per week | Hot Flashes Night time_________# per week | 
| Night sweats | Night Sweats _________# per week | 
| Night sweats - areas• • • | Vaginal dryness | 
| Intercourse symptoms• • • | Incontinence | 
| Estrogen Dominant |  | 
| Irregular periods |  | 
| Menstrual Frequency | Menstrual Flow | 
| Menstrual Pain/cramps | Uterine fibroids | 
| Water retention | Tender breasts | 
| Fibrocystic breasts | Increased forgetfulness | 
| Foggy thinking | Tearful | 
| Depressed | Mood swings | 
| Adrenal Function |  | 
| Stress |  | 
| Morning fatigue | Afternoon Fatigue | 
| Evening fatigue | Difficulty sleeping | 
| Decreased stamina | Anxious | 
| Irritable | Nervous | 
| Ringing in ears | Fibromyalgia | 
| Allergies | Headaches | 
| Sugar cravings | Dizzy spells | 
| Thyroid Function |  | 
| Cold body temperature |  | 
| Goiter | Hoarseness | 
| Hair dry or brittle | Nails breaking or brittle | 
| Constipation | Slow pulse rate | 
| Rapid Heartbeat/Heart palpations |  | 
| Metabolic Syndrome/High Androgen |  | 
| Infertility problems | Acne | 
| Increased facial hair/body hair | Scalp hair loss | 
| Weight gain-hips | Weight gain-waist | 
| High cholesterol | Elevated triglycerides | 
| Low Androgen/Other |  | 
| Decreased libido |  | 
| Decreased muscle size | Thinning skin | 
| Rapid aging | Aches and pains | 
| Bone loss | Comments | 

