Quiz for Women Name First Last PhoneBest Time to Call AM PM Email*(Required) Age MessageOn a scale of 0-3, from Never (0) to Mild (1) to Moderate (2) to Severe (3), how does this symptom effect you?DEPRESSIVE MOOD 0 1 2 3 MEMORY LOSS 0 1 2 3 MENTAL CONFUSION 0 1 2 3 DECREASE SEX DRIVE/LIBID 0 1 2 3 MOOD CHANGES/IRRITABILITY 0 1 2 3 TENSION 0 1 2 3 MIGRAINE/SEVERE HEADACHES 0 1 2 3 WEIGHT GAIN 0 1 2 3 BREAST TENDERNESS 0 1 2 3 VAGINAL DRYNESS 0 1 2 3 HOT FLASHES 0 1 2 3 NIGHT SWEATS 0 1 2 3 DRY AND WRINKLED SKIN 0 1 2 3 HAIR IS FALLING OUT 0 1 2 3 COLD ALL THE TIME 0 1 2 3 SWELLING ALL OVER THE BODY 0 1 2 3 BRAIN FOG 0 1 2 3 JOINT PAIN 0 1 2 3 DIFFICULTY FALLING ASLEEP 0 1 2 3 DIFFICULTY STAYING ASLEEP 0 1 2 3
