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Female Hormone Symptom Questionnaire

    Complete the questionnaire below to help find out whether your current symptoms may be due to your hormones.

    Developed by our experts, this questionnaire is often used by doctors as part of their assessment of a woman's symptoms and to monitor the results of treatment.

    Your Name (required)

    Your Email (required)

    Contact Number

    Date of Birth

    Vasomotor (Adrenaline Surges)

    Hot Flushes
    Night Sweats
    Panic Attacks
    Poor Sleep
    Vivid dreams nightmares


    Loss of confidence
    Mood swings / Hypo and hyperactive
    Reduced memory
    Depressed low feeling

    Insulin resistance/glucose intolerance

    Difficulty losing weight fluctuating weight
    Carbohydrate cravings/unusual hunger
    Facial Spots
    Increased facial body hair

    Bladder/Vaginal/Menstrual Symptoms

    Urinary urgency
    Vaginal dryness pain
    Lack of sexual interest performance
    Change of menstrual cycle

    If you have any other symptoms please detail them below

    Sign up to receive further information