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Health Check - Women's Symptom Review

Please review the symptom check list below and indicate any symptoms you are experiencing.

Symptom

none

mild

moderate

severe



Hot Flashes





Low Estrogen

Night Sweats





Vaginal Dryness





Incontinence





Irregular Periods





Estrogen Dominance

Uterine Fibroids





Water Retention





Tender Breasts





Fibrocystic Breasts





Increased Forgetfulness





Foggy Thinking





Tearful





Depressed





Mood Swings





Stress





Adrenal

Morning Fatigue





Difficulty Sleeping





Decreased Stamina





Anxious





Irritable





Nervous





Fibromyalgia





Allergies





Headaches





Sugar Cravings





Dizzy Spells





Cold Body Temperature





Thyroid

Goiter





Hoarseness





Hair Dry or Brittle





Nails Breaking or Brittle





Constipation





Slow Pulse Rate





Rapid Heartbeat





Heart Palpitations





Infertility Problems





Acne





Metabolic Syndrome High Androgens

Increased Facial/Body Hair





Scalp Hair Loss





Weight Gain – Hips





Weight Gain – Waist





High Cholesterol





Elevated Triglycerides





Decreased Libido





Low Androgens/ Other

Decreased Muscle Size





Thinning Skin





Ringing in Ears





Rapid Aging





Aches and Pains





Bone Loss





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