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20

Do you experience hot flashes or excessive sweating?

Yes Sometimes No

19

Have you noticed any palpitations or other noticeable heart irregularities?

Yes Sometimes No

18

Do you ever experience insomnia or sleep rhythm disturbances?

Yes Sometimes No

17

Have you been feeling more anxious lately than before?

Yes Sometimes No

16

Can you say that you are more prone to depression now than before?

Yes Sometimes No

15

Do you have headaches more often than before?

Yes Sometimes No

14

Have you noticed any dizziness lately?

Yes Sometimes No

13

Have you been feeling weakness or getting tired more quickly lately?

Yes Sometimes No

12

Do you notice tingling in your fingers and toes (paresthesia)?

Yes Sometimes No

11

Do you notice more hair loss than before?

Yes Sometimes No

10

Has the skin become dry and less elastic?

Yes Sometimes No

9

Do you notice that the mucous membranes of your mouth or eyes have become drier?

Yes Sometimes No

8

Do you have frequent urination or difficulty holding your urine?

Yes Sometimes No

7

Do you notice any pain in your joints, primarily in your fingers and toes?

Yes Sometimes No

6

Do you have any pain in your muscles and bones?

Yes Sometimes No

5

Do you ever feel "heavier"?

Yes Sometimes No

4

Do you experience dryness in the vagina, pain during intercourse, or notice irritation?

Yes Sometimes No

3

Has your attitude towards sexual life changed?

Yes Sometimes No

2

Have you had your body and cervix removed?

Yes Sometimes No

1

Have you had your ovaries removed?

Yes Sometimes No