Which of the following symptoms apply to you currently (in the last 2 weeks)? Please select the appropriate rating (None-Very Severe), using the drop down arrow for each symptom. For symptoms that do not currently apply or no longer apply, mark "none".
Hot Flashes
Sweating (night sweats or increase episodes of sweating)
Sleep problems (difficulty falling asleep, sleeping through the neight or waking up too early)
Depressive mood (feeling down, sad, on the verge of tears, lack of drive)
Irritability (mood swings, feeling aggressive, angers easily)
Anxiety (inner restlessness, feeling panicky, feeling nervous, inner tension)
Physical exhaustion (general decreas in muscle strength or endurance, decrease in work performance, fatigue, lack of energy, stamina or motivation)
Sexual Problems (change in sexual desire, sexual activity, orgasm and/or satisfaction)
Bladder problems (difficulty in urinating, increased need to urinate, incontinence)
Vaginal symptoms
Erectile changes (weaker erections, loos of morning erections)
Infrequent or absent ejaculations
Joint and muscular symptoms (joint pain or swelling, muscle weakness, poor recovery after exercise)
Difficulties with memory
Problems with thinking, concentrating or reasoning
Difficulty learning new things
Trouble thinking of the right word to describe persons, places or things when speaking
Increase in frequency of instensity of headaches or migraines
Hair loss, thinning, or change in texture
Feel cold all the time or have cold hands or feet
Weight gain or difficulty losing weight despite diet and exercise
Dry or wrinkled skin
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