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Fax: (531) 200-7545
1772 Sea Lark Ln, Navarre, FL
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Menopause & Perimenopause Quiz
1. My periods are irregular
Never
Often
Always
2. I have hot flashes or night sweats
Never
Often
Always
3. I have PMS symptoms (cramps, bloating, breast tenderness, headaches, irritability)
Never
Often
Always
4. I have sleep difficulties
Never
Often
Always
5. I feel tired, weak or even exhausted
Never
Often
Always
6. I feel sad, moody or overwhelmed
Never
Often
Always
7. I feel anxious and even have anxiety attacks
Never
Often
Always
8. I'm forgetful, fuzzy-minded or confused
Never
Often
Always
9. I'm irritable or out-of-sorts
Never
Often
Always
10. I have digestive problems (bloating, gas, diarrhea, constipation, nausea or heartburn)
Never
Often
Always
11. I suffer from stiffness or achy joints
Never
Often
Always
12. I struggle to lose weight or keep it off
Never
Often
Always
13. My libido and sexual desire are low
Never
Often
Always
14. I suffer from vaginal dryness
Never
Often
Always
15. I crave sweets or carbohydrates, especially when I'm tired
Never
Often
Always
16. My hair is clearly thinning
Never
Often
Always
Let's talk about your health overall.
Let's talk about your health overall.
17. Are you being treated for any disease or serious health condition?
Yes
No
18. Have you been diagnosed with osteopenia or osteoporosis?
Yes
No
19. Have you suffered from a hormonal imbalance in the past? (thyroid condition, PCOS, insulin resistance, diabetes?)
Yes
No
Let’s consider the level of stress in your life.
Let’s consider the level of stress in your life.
20. Is work a source of stress for you?
Yes
No
21. Do you feel overscheduled and rushed?
Yes
No
22. Do you skip meals, frequently diet, or mostly eat out?
Yes
No
23. Are your relationships a source of conflict or stress?
Yes
No
Let’s think about other demands on your body.
Let’s think about other demands on your body.
24. Do you have caffeine or soft drinks more than once a day?
Yes
No
25. Are you taking multiple prescriptions, or often use antibiotics?
Yes
No
26. Do you have concerns about your family health history?
Yes
No
27. Have you suffered a major emotional trauma recently? (such as divorce, separation, job loss, death of a loved one)
Yes
No
Now let’s review what kinds of support you give your body now.
Now let’s review what kinds of support you give your body now.
28. Do you eat protein at every meal?
Yes
No
29. Do you eat fruits & vegetables every day?
Yes
No
30. Do you eat breakfast every day?
Yes
No
31. Are carbohydrates and/or sweets a big part of your diet? (count pasta too!)
Yes
No
Now let’s review what kinds of support you give your body now.
Now let’s review what kinds of support you give your body now.
32. Do you exercise four or more times a week?
Yes
No
33. Do you get 7-8 hours of sleep per night?
Yes
No
34. Do you practice some form of stress reduction? (such as meditation or yoga)
Yes
No
35. Do you take high quality nutritional supplements, including omega-3?
Yes
No
You’re almost done!
You’re almost done!
36. Are you on HRT or trying to get off it?
Yes
No
37. Have you had a hysterectomy?
Yes
No
38. Are you taking some form of prescription birth control?
Yes
No
39. What’s your age?
Your First Name
Your Email Address
Submit