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Excellent! You’ve completed part one. We’d now like to ask you some yes and no questions to determine the demands you’re making on your body, and the support you’re giving yourself.

Great job — you’re nearly there! We just have a few last quick questions before you’re finished:

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	Symptom	1	2	3	4	5
1	Irregular periods
2	Hot flashes and/or night sweats
3	PMS-like symptoms (cramps, bloating, breast tenderness, headaches, and/or irritability)
4	Sleep difficulties
5	Fatigued and/or have loss of energy
6	Feeling sad, moody or overwhelmed
7	Feeling anxious, having anxiety attacks, or temporary heart palpitations
8	Feeling forgetful, fuzzy-minded or confused
9	Irritability or just not feeling like yourself
10	Bloating, gas, diarrhea, constipation or nausea
11	Stiff or achy joints
12	Weight gain, especially around the middle, in the past year
13	Loss of libido or a change in sexual desire
14	Vaginal dryness
15	Cravings (sweets, carbohydrates, etc.)
16	Thinning hair or hair loss

1	Are you being treated for any disease or serious condition?	Yes	No
2	Have you been diagnosed with osteopenia or osteoporosis?	Yes	No
3	Have you experienced a hormonal imbalance in the past (e.g., thyroid condition, PCOS, insulin resistance)?	Yes	No
4	Is your work a source of stress for you?	Yes	No
5	Do you feel overscheduled and rushed?	Yes	No
6	Do you skip meals or follow "crash" diet plans, or eat the majority of your meals out?	Yes	No
7	Do you experience a lot of conflict or stress in your relationships?	Yes	No
8	Do you have caffeine and/or soft drinks more than once a day?	Yes	No
9	Are you taking more than one prescription medication or do you frequently take antibiotics?	Yes	No
10	Do you have a family history of heart disease?	Yes	No
11	Have you experienced a major emotional trauma or loss in the last 5 years?	Yes	No
12	Do you eat protein at every meal?	Yes	No
13	Do you eat fruits and vegetables every day? (5 servings are recommended)	Yes	No
14	Do you eat breakfast every day?	Yes	No
15	Are carbohydrates and/or sweets a large part of your diet?	Yes	No
16	Do you exercise 4 or more times a week?	Yes	No
17	Do you get 7-8 hours of sleep per night?	Yes	No
18	Do you rest when you are feeling fatigued and do you make time for your needs?	Yes	No
19	Do you try to minimize toxins and processed foods in your diet?	Yes	No
20	Do you try to minimize stress in your daily life?	Yes	No
21	Do you take high-quality, pharmaceutical-grade nutritional supplements with essential fatty acids?	Yes	No

Are you on HRT* or trying to get off of it?
(*Hormone Replacement Therapy)

Have you had a hysterectomy?

Are you currently taking birth control pills or using a birth control patch or ring?

What is your age*?
(*We will be comparing your score against women in your age group.)

Thank you for completing your hormonal health profile. Click next and you’ll be on your way to getting your personalized results and recommendations.