Do You Qualify For Hormone Therapy? Take Our Quiz 1. Decline in your feeling of general well-being (general state of health, subjective feeling) NoneMildModerateSevereVery Severe 2. Hot Flashes NoneMildModerateSevereVery Severe 3. Heart Palpitations NoneMildModerateSevereVery Severe 4. Hair Loss NoneMildModerateSevereVery Severe 5. Dry or Brittle Hair NoneMildModerateSevereVery Severe 6. Anxiety NoneMildModerateSevereVery Severe 7. Depression NoneMildModerateSevereVery Severe 8. Tearful NoneMildModerateSevereVery Severe 9. Nervous NoneMildModerateSevereVery Severe 10. Mood Swings NoneMildModerateSevereVery Severe 11. Foggy Thinking NoneMildModerateSevereVery Severe 12. Headaches NoneMildModerateSevereVery Severe 13. Memory Lapse NoneMildModerateSevereVery Severe 14. Decreased Libido NoneMildModerateSevereVery Severe 15. Dry or Irritated Eyes NoneMildModerateSevereVery Severe 16. Aches & Pains NoneMildModerateSevereVery Severe 17. Constipation NoneMildModerateSevereVery Severe 18. Acne NoneMildModerateSevereVery Severe 19. Bone Loss NoneMildModerateSevereVery Severe 20. Tender Breasts NoneMildModerateSevereVery Severe 21. Fibrocystic Breast NoneMildModerateSevereVery Severe 22. Increased Urinary Urge NoneMildModerateSevereVery Severe 23. Vaginal Dryness NoneMildModerateSevereVery Severe 24. Evening Fatigue NoneMildModerateSevereVery Severe 25. Unable to Fall Asleep NoneMildModerateSevereVery Severe 26. Unable to Stay Asleep NoneMildModerateSevereVery Severe 27. Night Sweats NoneMildModerateSevereVery Severe 28. Morning Fatigue NoneMildModerateSevereVery Severe Your Name (required) Your Email (required) Your Phone Number (required)
