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18

Poor memory (You walk into a room to do something and forget why you went there, or lose your train of thought mid-sentence)?

Yes No

17

Emotional vulnerability, especially compared to how you felt ten years ago?

Yes No

16

Depression, possibly with anxiety or severe lethargy (or dysthymia - mild depression lasting more than two weeks)?

Yes No

15

The appearance of wrinkles?

Yes No

14

Night sweats or hot flashes?

Yes No

13

Sleep problems, waking up in the middle of the night?

Yes No

12

Leaky or overactive bladder?

Yes No

11

Urinary bladder infections?

Yes No

10

Sagging breasts or reduction in breast size?

Yes No

9

The harm from sunlight is too obvious, even dangerous, on the chest, face, and shoulders.

Yes No

8

Joint problems?

Yes No

7

Recent injuries, especially to the wrists, shoulders, lower back, or knees?

Yes No

6

Loss of interest in physical activity?

Yes No

5

Bone mass loss?

Yes No

4

Vaginal dryness, irritation, or loss of sensation?

Yes No

3

Lack of moisture in other areas (dry eyes, dry skin, dry clitoris)?

Yes No

2

Low libido (it has decreased and is now noticeably lower than before)?

Yes No

1

Painful sensations during sex?

Yes No