HEALTH ASSESSMENT

Hot flashes

NoneMildModerateSevereVery severe

Sweating (night sweats or excessive sweating)

NoneMildModerateSevereVery severe

Sleep problems (difficulty falling asleep, sleeping through the night or waking up too early)

NoneMildModerateSevereVery severe

Depressive mood (feeling down, sad, lack of drive)

NoneMildModerateSevereVery severe

Irritability (mood swings, feeling aggressive, angers easily)

NoneMildModerateSevereVery severe

Anxiety (inner restlessness, feeling panicked, feeling nervous, inner tension)

NoneMildModerateSevereVery severe

Physical exhaustion (general decrease in muscle strength or endurance, decrease in work performance, fatigue, lack of energy, stamina or motivation)

NoneMildModerateSevereVery severe

Sexual problems (change in sexual desire, sexual activity, orgasm and/or satisfaction)

NoneMildModerateSevereVery severe

Bladder problems (difficulty urinating, increased need to urinate)

NoneMildModerateSevereVery severe

Vaginal symptoms (sensation of dryness or burning in vagina, difficulty with sexual intercourse)

NoneMildModerateSevereVery severe

Joint and muscular symptoms (joint pain or swelling, muscle weakness, poor recovery after exercise)

NoneMildModerateSevereVery severe

Difficulties with memory

NoneMildModerateSevereVery severe

Problems with thinking, concentrating or reasoning

NoneMildModerateSevereVery severe

Difficulties learning new things

NoneMildModerateSevereVery severe

Trouble thinking of the right word to describe persons, places or things when speaking

NoneMildModerateSevereVery severe

Increase in frequency or intensity of headaches/migraines

NoneMildModerateSevereVery severe

Rapid hair loss or thinning

NoneMildModerateSevereVery severe

Feel cold all the time or have cold hands or feet

NoneMildModerateSevereVery severe

Weight gain, increased belly fat, or difficulty losing weight despite diet and exercise

NoneMildModerateSevereVery severe

Dry or wrinkled skin

NoneMildModerateSevereVery severe

SUBMIT

Sweating (night sweats or excessive sweating)

NoneMildModerateSevereVery severe

Sleep problems (difficulty falling asleep, sleeping through the night or waking up too early)

NoneMildModerateSevereVery severe

Increased need for sleep or falls asleep easily after a meal

NoneMildModerateSevereVery severe

Depressive mood (feeling down, sad, lack of drive)

NoneMildModerateSevereVery severe

Irritability (mood swings, feeling aggressive, angers easily)

NoneMildModerateSevereVery severe

Anxiety (inner restlessness, feeling panicked, feeling nervous, inner tension)

NoneMildModerateSevereVery severe

Physical exhaustion (general decrease in muscle strength or endurance, decrease in work performance, fatigue, lack of energy, stamina or motivation)

NoneMildModerateSevereVery severe

Sexual problems (change in sexual desire or in sexual performance)

NoneMildModerateSevereVery severe

Bladder problems (difficulty urinating, increased need to urinate)

NoneMildModerateSevereVery severe

Erectile changes (weaker erections, loss of morning erections)

NoneMildModerateSevereVery severe

Joint and muscular symptoms (joint pain or swelling, muscle weakness, poor recovery after exercise)

NoneMildModerateSevereVery severe

Difficulties with memory

NoneMildModerateSevereVery severe

Problems with thinking, concentrating or reasoning

NoneMildModerateSevereVery severe

Difficulties learning new things

NoneMildModerateSevereVery severe

Trouble thinking of the right word to describe persons, places or things when speaking

NoneMildModerateSevereVery severe

Increase in frequency or intensity of headaches/migraines

NoneMildModerateSevereVery severe

Rapid hair loss or thinning

NoneMildModerateSevereVery severe

Feel cold all the time or have cold hands or feet

NoneMildModerateSevereVery severe

Weight gain, increased belly fat, or difficulty losing weight despite diet and exercise

NoneMildModerateSevereVery severe

Infrequent or absent ejaculations

NoneMildModerateSevereVery severe

SUBMIT