Please select for EACH symptom you are currently experiencing

For symptoms that do not apply, please mark NONE.

Hot flashes, sweating (episodes of sweating) *
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Heart Discomfort (heart skipping, heart racing, tightness)*
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Sleep problems (Difficulty in falling asleep)*
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Depressive mood (Feeling down, sad, on the verge of tears)*
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Irritability (Feeling nervous, inner tension, feeling aggressive)*
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Anxiety (Inner restlessness, feeling panicky)*
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Physical & mental exhaustion (Impaired memory and/or focus)*
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Sexual problems (Change in desire, activity, & satisfaction*
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Bladder Problems (Difficulty in urinating or need to urinate)*
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Dryness of vagina (Sensation of dryness or burning)*
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Joint and muscular discomfort (Pain in the joints)*
  • None
  • Mild
  • Moderate
  • Severe
  • Extremely Severe
  • No elements found. Consider changing the search query.
  • List is empty.
Do you have cold hands and feet?*
  • Yes
  • No
  • No elements found. Consider changing the search query.
  • List is empty.
Do you have daily bowel movements?*
  • Yes
  • No
  • No elements found. Consider changing the search query.
  • List is empty.
Do you have gas, bloating or abdominal pain after eating?*
  • Yes
  • No
  • No elements found. Consider changing the search query.
  • List is empty.

Please select your WEEKLY Activity Level based on this criteria  Physical activity that accelerates heart rate / Breathlessness

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