Women’s Health Survey

1. How much do you experience fatigue?

 
 
 
 

2. How much are allergies a problem in your life?

 
 
 
 

3. Do you notice signs of rapid aging?

 
 
 
 

4. How much do you experience anxiety?

 
 
 
 

5. Do you get breast tenderness?

 
 
 
 

6. Have you noticed a decreased sex drive?

 
 
 
 

7. How much do you deal with depression?

 
 
 
 

8. Have you noticed weight gain, especially around the abdomen, hips, and thighs?

 
 
 
 

9. Have you experienced hair loss?

 
 
 
 

10. How much do you deal with headaches?

 
 
 
 

11. Do you ever notice symptoms of low blood sugar (dizziness, irritability, difficulty concentrating)?

 
 
 
 

12. Do you have trouble falling or staying asleep?

 
 
 
 

13. How much do you experience irritability?

 
 
 
 

14. Do you have a hard time remembering things (like where you put your keys or purse)?

 
 
 
 

15. How much do you (or did you in the past if you're post-menopause) experience Premenstrual Syndrome, or PMS?

 
 
 
 

16. Do you feel bloating very often?