Gallery

Menopause Hormone Quiz

Tables

Quiz 2.0

Follow-up Intake

Ideas

Stuff

Explore

Stuff

Hormone Types

Menopause Type Questionnaire

SECTION A

1. Are you having hot flashes or night sweats, or both?

2. Are you feeling more depressed? Are you more

withdrawn or isolated? Do you feel periods of

hopelessness? Do you feel apathetic?

3. Do you feel a loss of energy? Do you feel more

fatigued?

4. Do you feel less receptive to sex? Do you feel less

sensual? Do you feel that your sex drive is diminished?

5. Are you having increased vaginal pain, dryness or

itching?

Are you having insomnia, difficulty falling to sleep or

difficulty staying asleep?

7. Are you having trouble with your memory? Do you feel

like you are having more trouble remembering names?

Are you more forgetful?

8. Is your mood low, less upbeat, less positive or less

outgoing? Are you having less "good moods' and times of

joy? Do you find yourself caring less about things that

used to matter to you?

9. Are you having trouble controlling your urine? Do you

have to go more often? Do you spill urine when you

cough or sneeze?

10. Do you feel as if your perception is weakening, that it

takes you longer to notice things? Are you having trouble

thinking of the right word when speaking or writing? Do

you feel your mental skills are diminishing?

SECTION B

Are you having more aches and pain? Are you starting

to get arthritis?

2. Are you having more spotting or break-through

bleeding? Have you been told you have Dysfunctional

Uterine Bleeding?

3. Do you seem to be getting more inflammations and

swellings?

Are your allergies or asthma getting worse, or are you

developing new allergies or asthma?

5. Do you feel like you are having more twitches and

spasms?

6. Are you experiencing times of mental fogginess, or

trouble thinking clearly?

7. Are you having more mood swings?

8. Do you feel more fatigued? Are you more tired in the

morning?

9. Are you more irritable? Do you have more nervous

tension?

10. Are you experiencing more anxiety? Do you feel more

anxious?

SECTION C

1. Do you feel less motivated in general? Do you feel less

assertive?

2. Is your libido lessened? Are you having less sexual

fantasies or less desire? Are you less likely to become

sexually aroused? Are you less pleased with sex?

3. Are you feeling less composed and in control?

Are you less energetic?

Are you anemic, or think you are anemic?

Are you feeling more irritable?

Do you have less muscle strength? Do you feel weaker?

8. Are you having more trouble with mental skills requiring

logic and problem solving? Are you having trouble focusing

and maintaining your attention?

9. Is your memory weakening? Are you having more trouble

remembering things and events?

10. Do you feel more depressed? Is your mood low, less

confident? Are you feeling frightened or afraid?

SECTION D

1. Are you noticing more wrinkles around your mouth and

eyes? Do you have poor skin tone on you arms legs or

hands? Has the skin lost its firmness or fullness?

2. Do you feel more depressed?

Do you feel more fatigue in general?

Are you having more headaches?

Are you having more heart palpitations or flutters?*

Section E:

1. Do your breasts feel as if they are shrinking and sagging?

2. Are you experiencing more confusion?

Are you experiencing more morning fatigue?

Do you cry more easily, or more often?

5. Are your hands or feet colder?

Section F:

Is your libido less than it used to be?

Is your pubic hair thinning?

Do you feel less motivation, less assertive, less confident?

Have you lost your competitive edge?

Are you gaining more fat weight? Do you feel less lean?

Are you having more low back pain or hip pain? Do you

feel more joint pain? Are you having more headaches?

SECTION G

1. Are you developing more facial Hair (hirsutism)?

2. Is your voice changing and becoming deeper or less

feminine?

3. Are you having trouble tolerating sugars and

carbohydrates?

Are you developing or having increased acne?

5. Do you feel more hostile, angry, agitated or aggressive?

Want to print your doc?
This is not the way.

Try clicking the ⋯ next to your doc name or using a keyboard shortcut (

CtrlP

) instead.