Symptoms

None

Mild

Moderate

Severe

Fatigue

0

1

2

3

Low Libido

0

1

2

3

Anxiety

0

1

2

3

Hair Loss

0

1

2

3

Moodiness

0

1

2

3

Fuzzy Thinking

0

1

2

3

Cravings for Sweets

0

1

2

3

Food Cravings

0

1

2

3

Irritability

0

1

2

3

Insomnia

0

1

2

3

Headaches

0

1

2

3

Emotional Swings

0

1

2

3

Depression

0

1

2

3

Weight Gain

0

1

2

3

Short Term Memory Loss

0

1

2

3

Inability to Concentrate

0

1

2

3

Hot Flashes

0

1

2

3

Shortness of Breath

0

1

2

3

Heart Palpitations

0

1

2

3

Sleep Disorders

0

1

2

3

Vaginal Dryness

0

1

2

3

Dry Hair/Skin

0

1

2

3

Swollen Breasts

0

1

2

3

Mood Swings

0

1

2

3

Cramps

0

1

2

3

Painful Breasts

0

1

2

3

Bloating

0

1

2

3

Frequent UTI's

0

1

2

3

Frequent Yeast Infections

0

1

2

3

Loss of Pubic Hair

0

1

2

3

Painful Intercourse

0

1

2

3

Night Sweats

0

1

2

3

Inability to Reach Orgasm

0

1

2

3

Water Retention

0

1

2

3

Fibrocystic Breasts

0

1

2

3

Cold Hands/Feet

0

1

2

3