Women's Symptoms

Women's Symptoms Checklist

Yes

No

1

Do you experience hot flashes?

2

Do you have night sweats?

3

Do you have a degree of vaginal dryness?

4

Is your thinking foggy at times?

5

Do you forget peoples names and or objects?

6

Do you have a decrease in libido (sex drive)?

7

Do you have trouble remembering directions and or numbers?

8

Do you have a diminished feeling of well being?

9

Do you find it difficult to hold back your emotions or tears?

10

Do you have a decrease in strength?

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