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Which of the following symptoms apply to you currently (in the last 2 weeks)?
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Hot flashes
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Sweating (night sweats or increased episodes of sweating)
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Sleep problems (difficulty falling asleep, sleeping through the night or waking up too early)
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Depressive mood (feeling down, sad, on the verge of tears, lack of drive)
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Irritability (mood swings, feeling aggressive, angers easily)
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Anxiety (inner restlessness, feeling panicky, feeling nervous, inner tension)
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Physical exhaustion (general decrease in muscle strength or endurance, decrease in work performance, fatigue, lack of energy, st
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Sexual problems (change in sexual desire, sexual activity, orgasm and/or satisfaction)
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Bladder problems (difficulty in urinating, increased need to urinate, incontinence)
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Vaginal symptoms (sensation of dryness or burning in vagina, difficulty with sexual intercourse)
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Joint and muscular symptoms (joint pain or swelling, muscle weakness, poor recovery after exercise)
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Difficulties with memory
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Problems with thinking, concentrating or reasoning
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Difficulty learning new things
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Trouble thinking of the right word to describe persons, places or things when speaking
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Increase in frequency or intensity of headaches or migraines
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Hair loss, thinning or change in texture of hair
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Feel cold all the time or have cold hands or feet
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Weight gain or difficulty losing weight despite diet and exercise
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Dry or wrinkled skin
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Total score
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Severity score: Mild: 1-20/ Moderate: 21-40/ Severe: 41-60/ Very severe: 61-80
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