Dear Reader,
please select any symptoms you have experienced in the last 3 months. This questionnaire will give your health care practitioner a quick summary of symptoms or signs of hormonal imbalance. It is not a substitute for professional medical advice from your health care provider.
1. My menstrual periods are irregular A. yes B. no
2. I have hot flashes or night sweats A. yes B. no
3. I suffer from premenstrual syndrome such as cramps A. yes B. no
4. I have difficulty falling asleep A. yes B. no
5. I have difficulty staying asleep A. yes B. no
6. I feel very tired; especially in the afternoon A. yes B. no
7. I am fatigue or have loss of energy through the day A. yes B. no
8. I have mood swings A. yes B. no
9. I am sad, irritable or depressed A. yes B. no
10. I am anxious, have anxiety attacks, or has
heart palpitations A. yes B. no
11. I am forgetful, fuzzy minded or absent minded A. yes B. no
12. I sometimes feel overwhelmed, confused, or just A. yes B. no
not myself
13. I feel that I've gained weight compared to last year A.yes B.no
especially around the middle / abdomen
14. I suffer from vaginal dryness A. yes B. no
15. I crave for sweets, carbohydrates or alcohol A. yes B. no
16. I have hair that is dry, fragile, or thinning and or A. yes B. no
skin that is dry
17. I have lost some inches of height A. yes B. no
18. I have suffer from broken or fractured bones A. yes B. no
19. I suffered from yeast or urinary tract infections A. yes B. no
20. My interest in sex isn't what it used to b with A. yes B. no
my spouse / partner
Note : If your answer : 90 % (A-yes); need an advice from a doctor
If your answer : 90% (B-no); maintain your healthy lifestyle.
Healthy Lifestyle is to balance your immune systems.
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