1) Do You Experience Irregular Periods?

Yes

No

2) Do You Experience Sleep Issues?

Yes

No

3. Do You Experience Stomach Issues?

Yes

No

4. Do You Sometimes Experience Extreme Fatigue?

Yes

No

5. Do You Find Yourself Getting Moody and Having The Blues?

Yes

No

6. Have You Experienced Weight Gain?

Yes

No

7. Do You Experience Headaches?

Yes

No

8. Do You Have a Lower Libido?

Yes

No

9) Do You Experience Any Breast Changes?

Yes

No

10) Do You Experience Night Sweats?

Yes

No

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Email *

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