Step 1 of 714%Name*Email PhoneDate Date Format: MM slash DD slash YYYY Section A1. Are you experiencing hot flashes or night sweats, or both?* YES NO2. Are you feeling more depressed? Are you more withdrawn or isolated? Do you fell periods of hopelessness? Do you feel apathetic?* YES NO3. Do you feel a loss of energy? Do you feel more fatigued?* YES NO4. Do you feel less receptive to sex? Do you feel less sensual? Do you feel that your sex drive has diminished?* YES NO5. Are you having increased vaginal pain, dryness, or itching?* YES NO6.Are you experiencing insomnia, difficulty falling asleep, or difficulty staying asleep?* YES NO7. Are you having trouble with your memory? Are you having more trouble remembering names? Are you more forgetful?* YES NO8.Is your mood low, less upbeat, less positive, or less outgoing? Are you having less "good moods" and times of joy? Do you find yourself caring less about things that used to matter to you?* YES NO9.Are you having trouble controlling your urine? Do you have to go more often? Do you spill urine when you cough or sneeze?* YES NO10. Do you feel as if your perception is weakening, that it takes you longer to notice things? Are you having trouble thinking of the right word when speaking or writing? Do you feel your mental skills are diminishing?* YES NOSection B1. Are you having more aches and pain? Are you starting to get arthritis?* YES NO2. Are you having more spotting or breakthrough bleeding? Have you been told you have dysfunctional uterine bleeding?* YES NO3. Do you seem to be getting more inflammations and swellings? _______* YES NO4. Are your allergies or asthma getting worse, or are you developing new allergies or asthma?* YES NO5. Do you seem to be having more twitches and spasms?* YES NO6. Are you experiencing times of mental fogginess, or trouble thinking clearly?* YES NO7. Are you having more mood swings?* YES NO8. Do you feel more fatigued? Are you more tired in the morning?* YES NO9. Are you more irritable/ Do you have more nervous tension?* YES NO10. Are you experiencing more anxiety? Do you feel more anxious?* YES NOSection C1. Do you feel less motivated in general? Do you feel less assertive?* YES NO2. Has your libido lessened? Are you having fewer sexual fantasies or less desire? Are you less likely to become sexually aroused? Are you less pleased with sex?* YES NO3. Are you feeling less composed and in control?* YES NO4. Are you less energetic?* YES NO5. Are you anemic, or do you think you are anemic?* YES NO6. Are you feeling more irritable?* YES NO7. Do you have less muscle strength? Do you feel weaker?* YES NO8. Are you having more trouble with mental skills requiring logic and problem solving? Are you having trouble focusing and maintaining your attention?* YES NO9. Is your memory weakening? Are you having more trouble remembering things and events?* YES NO10. Do you feel more depressed? Is your mood low, less confident? Are you feeling frightened or afraid?* YES NOSection D1. Are you noticing more wrinkles around your mouth and eyes? Is the skin tone on your arms, legs, or hands poor? Has the skin lost its firmness or fullness?* YES NO2. Do you feel more depressed? Has the skin lost its firmness or fullness?* YES NO3. Do you feel more fatigued in general?* YES NO4. Are you having more headaches?* YES NO5. Are you over 45 years old?* YES NOSection D1. Does it seem as though your breasts are shrinking and sagging?* YES NO2. Are you experiencing more confusion?* YES NO3. Are you experiencing more morning fatigue?* YES NO4. Do you cry more easily or more often?* YES NO5. Are your hands or feet colder than usual?* YES NOSection F1. Is your libido less than It used to be?* YES NO2. Is your pubic hair thinning?* YES NO3. Do you feel less motivated, less assertive, and less confident? Have you lost your competitive edge?* YES NO4. Are you gaining more body fat? Do you feel less lean?* YES NO5. Are you having more lower back pain or hip pain? Do you feel more joint pain? Are you having more headaches?* YES NOSection G1. Are you developing more facial hair?* YES NO2. Is your voice changing and becoming deeper or more masculine?* YES NO3. Are you having trouble tolerating sugars and carbohydrates?* YES NO4. Are you developing or experiencing increased acne?* YES NO5. Do you feel more hostile, angry, agitated, or aggressive?* YES NO