Female Hormone Quiz - Rose Wellness

Are you experiencing hot flashes?

Yes
No

Do you feel exhausted on a daily basis?

Yes
No

Do you suffer from headaches/migraines?

Yes
No

Do you suffer from night sweats?

Yes
No

Are you experiencing vaginal dryness?

Yes
No

Have you noticed loss of bladder control or frequent urination?

Yes
No

Are you noticing bouts of mild to severe depression?

Yes
No

Have you had a history of recent urinary tract infections?

Yes
No

Has there been an increase in forgetfulness?

Yes
No

Are you having trouble concentrating?

Yes
No

Have you noticed a decrease in your ability to explain things?

Yes
No

Do you suffer from occasional bouts of rapid heartbeat?

Yes
No

Are you more emotional?

Yes
No

Do you cry easily?

Yes
No

Are you noticing lumpiness in your breasts?

Yes
No

Are you experiencing anxiety?

Yes
No

Do you have irregular periods?

Yes
No

Do you become easily stressed?

Yes
No

Are you increasingly becoming moody with age?

Yes
No

Are you experiencing breakthrough bleeding?

Yes
No

Do you suffer from moderate ot severe menstrual cramps or PMS?

Yes
No

Do you have low body temperature?

Yes
No

Do you have or have a family history of endometriosis?

Yes
No

Do you suffer from sleep disturbances?

Yes
No

Do you have heavy periods?

Yes
No

Do you have joint or muscle pain?

Yes
No

Are you experiencing pain in multiple areas of your body?

Yes
No

Have you had an unexplained increase in weight?

Yes
No

Has your sex drive decreased?

Yes
No

Have you noticed increased belly fat?

Yes
No

Have you noticed an increase in the size of your breasts?

Yes
No

Are you developing cellulite?

Yes
No

Have you had a decrease in self esteem?

Yes
No

Do you feel like flopping onto the couch after work?

Yes
No

Are your eyelids drooping?

Yes
No

Have you noticed that your hair is thinning?

Yes
No

Do you feel hypersensitive?

Yes
No

Are you gaining weight?

Yes
No

Are your muscles turning to flab?

Yes
No

Do you have high triglycerides, high LDL & low HDL?

Yes
No

Do you have diminished Physical Performance?

Yes
No

First Name *

Last Name *

Email *

Phone *

What state do you reside in? *

Primary Health Concern *

I agree the quiz results are for informational purposes only and not designed to diagnose or treat my specific conditions. I consent to be added to the Rose Wellness free newsletter and be contacted by them.