Female Hormone Assessment (Prospects)

Female Hormone Assessment

Symptoms in last 2 weeks

	None	Mild	Moderate	Severe	Very Severe
Physical exhaustion (general decrease in muscle strength or endurance, decrease in work performance, fatigue, lack of energy, stamina or motivation)
Sleep problems (difficulty falling asleep, sleeping through the night, or waking to early)
Irritability (mood swings, feeling aggressive, angers easily)
Anxiety (inner restlessness, feeling panicky, feeling nervous, inner tension)
Decline in drive or interest (loss of "zest for life, feeling down or sad")
Joint and muscular symptoms (joint pain or swelling, muscle weakness, poor recovery after exercise)
Difficulty with memory (concentration, finding the right right word, or retaining information)
Vaginal symptoms (sensation of dryness or burning in vagina, difficulty with sexual intercourse)
Sexual problems (change in desire, sexual activity, orgasm and/or satisfaction)
Sweating (night sweats or increased episodes of sweating)
Hot flashes (burst that starts in chest and last for short duration)
Hair loss, thinning or change in texture of hair
Feels cold all of the time or have cold hands or feet
Increase in frequency or intensity Of headaches or migraines
Weight gain or difficulty losing weight despite diet and exercise
Bladder problems ( difficulty urinating, increased need, incontinence)

SUM
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