Hormonal Health Questionnaire for Menopausal Women
Disclaimer: This questionnaire is a guideline to help you understand potential hormonal imbalances. It is not a diagnostic tool. Please consult with a healthcare provider for a comprehensive evaluation.
For each statement, rate your experience over the past month on a scale of 0 to 4:
Form
1
I experience hot flashes or night sweats.
I have experienced unexplained weight gain, especially around the abdomen.
I feel more fatigued than usual.
I've noticed increased vaginal dryness.
I'm having difficulty falling or staying asleep.
My mood feels consistently low or I feel depressed.
I've experienced memory issues or brain fog.
I notice more frequent urinary urgency or leakage.
I often feel hungrier than usual, even soon after meals.
I've experienced spotting between periods or unusual menstrual patterns.
I feel mood swings more frequently.
I've been feeling more irritable or have more nervous tension.
My allergies or asthma seem to have gotten worse.
I've noticed more frequent headaches or migraines.
My libido has noticeably decreased.
My muscle strength seems to have diminished.
I feel less energetic overall.
My hair on the scalp has started to thin or fall out more than usual
I consume alcohol more than three times a week.
I engage in regular physical activity (at least 30 minutes, 3 times a week).
I have a history of thyroid or other hormonal disorders.
I'm currently on any hormone replacement therapy or birth control.
My diet is mostly balanced with fruits, vegetables, proteins, and grains.
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Interpreting Your Score:
Your results from this questionnaire are categorized based on the three predominant hormones that often play key roles during menopause: Estrogen, Progesterone, and Testosterone (including other androgens).
The scores provide a general insight into which hormone imbalances might be causing your symptoms.
They range from low to high, indicating the likelihood of a hormone deficiency.
It's essential to note that this is a broad overview and not a definitive diagnosis. Our bodies are complex, and many factors can contribute to our overall well-being. This score is a tool to give you a starting point for conversations with healthcare professionals and to guide potential lifestyle adjustments.
Below, you'll find the breakdown of your scores for each hormone section. Use them to inform, not alarm. Let's dive in!
Section A: Estrogen-Related Symptoms (out of 32):
0-10: Low symptoms (Low likelihood of estrogen deficiency)
11-16: High symptoms (Higher likelihood of testosterone and/or androgen deficiency)
Your Results..
Estrogen:
16
Possible mild estrogen deficiency
Progesterone:
5
Low likelihood of progesterone deficiency
Testosterone:
10
Possible mild testosterone deficiency
As you embark on this self-discovery journey, we'd like to offer some pointers and clarifications:
Purpose of the Questionnaire: This tool is designed to provide insights into potential hormonal imbalances based on your symptoms. It's an invitation to better understand your body and its unique hormonal landscape.
Interpretation and Limitations: While we've developed this questionnaire using evidence-based knowledge, it's essential to remember that it offers generalized insights. Each individual's hormonal makeup is intricate, and this tool serves as a starting point, not a diagnostic tool.
Hormonal Interactions: Hormones operate in a delicate balance. Sometimes, an imbalance in one hormone can influence others. It's beneficial to view your results holistically, considering how different hormones might interact and influence your well-being.
Consultation is Key: If your results suggest potential imbalances, or if you're concerned about any symptoms, please consult a healthcare professional. They can provide personalized advice, diagnostic testing, and tailored strategies to address any imbalances.
Journey, Not a Destination: Hormonal levels can fluctuate due to various factors like age, lifestyle, stress, and more. It's helpful to revisit this questionnaire periodically and stay attuned to your body's signals.
You're Not Alone: Remember, hormonal imbalances are a common experience for many women. Whether you're navigating the nuances of menopause or simply curious about your hormonal health, you're part of a community. We're here to support and guide you.
Thank you for choosing to explore your hormonal health with us. We wish you clarity, understanding, and the empowerment to make informed choices for your well-being.
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