Hormone & Weight Loss Questionnaire
Full Name
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Physical Exhaustion (fatigue, lack of energy, stamina or motivation)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Sleep Problems (difficulty falling asleep or sleeping through the night)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Irritability (mood swings, feeling aggressive, angers easily)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Anxiety (feeling overwhelmed, feeling panicky, or feeling nervous)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Decline in drive or interest (loss of "zest for life," feeling down or sad)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Joint and muscular symptoms (joint pain, muscle weakness, poor recovery after exercise)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Difficulties with memory (concentration, finding the right word, or retaining information)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Vaginal dryness or difficulty with sexual intercourse
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Sexual Problems (change in desire, activity, orgasm and/or satisfaction)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Hair loss, thinning or change in texture of hair
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Hot Flashes (bursts that starts in chest and lasts for short duration)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Sweating (night sweats or increased episodes of sweating)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Feeling cold all of the time, having cold hands or feet
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Headaches or migraines (increase in frequency or intensity)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Weight (difficulty losing weight despite diet/exercise)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Bladder problems (difficulty in urinating, increased need to urinate, incontinence)
None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.
Other symptoms or unique health circumstances to take into consideration:
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