Have you been experiencing bladder symptoms (urgency, frequency, leakage) (copy) *

Yes

No

Have you noticed a decrease in your sex drive or libido *

Yes

No

Have you been experiencing an increase in fatigue? *

Yes

No

Have you noticed hair loss or thinning? *

Yes

No

Have you been experiencing headaches more often than before? *

Yes

No

Have you felt heart palpitations (a racing or fluttering heartbeat)? *

Yes

No

Are you experiencing hot flashes or night sweats? *

Yes

No

Has there been an increase in your joint pain or stiffness? *

Yes

No

Are you experiencing memory loss or difficulty concentrating ('brain fog')? *

Yes

No

Have you been experiencing mood swings? *

Yes

No

Have you noticed an increase in nervousness or irritability? *

Yes

No

Are you having sleep disruptions or difficulty sleeping through the night? *

Yes

No

Are you experiencing vaginal dryness? *

Yes

No

Have you had an increase in yeast infections or UTIs? *

Yes

No