Female Hormonal Questionnaire<br>Category 1.3: For those with ovaries and uterus.

Periods are becoming more normal after being heavy for some time

Please put a check next to any symptoms you experience during one month's cycle.

Physical Chronic fatigue Exhaustion Headaches Migraines Heart races or palpitates Shortness of breath Dizzy spells Midriff weight gain Water retention Pressure in head, eyes, forehead Pressure in the sinuses Feeling hotter than others in the room Hot flashes Tight muscles in head, neck and shoulders Low thyroid Facial hair growth Scalp hair loss Hair growth in unwanted places Pimple or acne on the face or body Tender or painful breasts Cystic breasts Breast lumps or tumors Poly cystic ovaries Endometriosis Uterine fibroids Mental Mental fog Mental confusion Poor concentration Forgetfulness Short term memory loss Physical Vaginal infections Bladder infections Vaginal itching and/or burning Vaginal tissue growing closed Falling uterus Bladder shrinkage Urinary frequency Urinary leakage (incontinence) High blood pressure Ringing in the ears Changes in eyesight Dry eyes Lowered immune function Bone loss Osteopenia Nervous system disorders Auto immune disorders Lupus Cervical thickening Irregular PAP smear Breast cancer Cervical cancer Uterine cancer Vaginal cancer Vulva cancer Menstrual More than 28 days between periods Periods less than 7 days Periods getting lighter Spotting between periods Painful cramps Painful ovulation Miscarriages Emotional Anxiety Excessive worry or fixed attention Panic attack Nervousness Depression Feeling sad or close to tears Crying spells Suicidal thoughts Postpartum depression Abnormal irritability to rage Mood swings Sexual Decreasing sexual desire Decreased sensitivity in erogenous zones Irritating when touched in erogenous zones Decreased ability to climax No sexual desire Inability to climax Painful intercourse Orgasm headache Bleeding after intercourse Sleep Trouble falling asleep Insomnia Restless sleep Trouble staying asleep Waking too early Excessive dreaming Nightmares Getting up one or more times to urinate
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