Female Hormone – Self Test

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Check any of the following statements that apply

 

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  • Have you had a hysterectomy?
  • YesNo

Do you?

  • Have a history of antibiotic use
  • Continuously use prescription medication
  • Take synthetic hormones in topical cream, patch or orally
  • Experience difficulty sleeping
  • Experience mood swings
  • Experience hot flashes
  • Experience low libido
  • Drink more than one glass of alcohol weekly
  • Drink caffeine daily
  • Experience exhaustion
  • Experience irregular menstrual cycle
  • Experience infertility
  • Experience frequent urination

Menstrual or Menopause Concern Ovarian Dysfunction

Do You Have… ?

  • Vaginal dryness, pain
  • Painful intercourse
  • Engorged breasts
  • Milk production (not nursing)
  • Lack of interest in sex
  • Blurred vision
  • Headache
  • Acne and/or oily skin
  • Aggressive feelings
  • Overwhelming sexual urges
  • Absence of menstrual flow for six or more months
  • Occasionally skip periods
  • Menstruation began after 16 years old
  • Breasts shrinking
  • Thinning pubic and armpit hair
  • Unable to get pregnant
  • Miscarriage
  • Excessfacial hair
  • Poor sense of smell
  • Monthly abdominal pain without bleeding
  • Menstrual type pain between menses
  • Irregular time intervals between periods
  • Menstrual cycles greater than 32 days
  • Menstrual cycles less than 24 days
  • Vaginal bleeding between periods
  • Pain during periods is getting progressively worse
  • Pain, cramps

Premenstrual Syndrome, (3 days to 2 weeks prior to menstruation)

Do You Have… ?

  • Premenstrual tension
  • Painfulmenses (cramping etc.)
  • Menstruation excessive or prolonged
  • Painful/tender breasts
  • Menstruate too frequently
  • Acne, worse at menses
  • Depressed feelings before menstruation
  • Vaginal discharge
  • Menses scanty or missed
  • Hysterectomy/ovaries removed
  • Depression
  • Insomnia
  • Abdominal bloating
  • Breast tenderness, swelling
  • Depressed,irritable, nervous
  • Easy to anger, resentful
  • Easily overwhelmed
  • Nausea and/or vomiting
  • Diarrhea or constipation
  • Headache
  • Food cravings, binge eating
  • Back pain
  • Feel faint
  • Clumsiness
  • Forgetful
  • Weight gain-water
  • Suicidal

Dysplasia / Fibrocystic Syndrome

Do You Have… ?

  • Lumps are painful, tender
  • Clear, gray or yellow vaginal discharge
  • Vaginal bleeding after sex or between periods
  • Burning or itching or external genitalia
  • Urgent,painful urination
  • Lower abdominal or back pain
  • Heavy, watery and bloody vaginal discharge
  • Heavy menstrual flow
  • Pelvic cramps
  • Thin, scant white vaginal discharge
  • Greenish yellow or offensive discharge
  • Cheesy white discharge
  • Breast lumps or swelling
  • Lumps hurt just before period
  • Swelling under armpit
  • Change in breast size, shape
  • White or slightly bloody vaginal discharge, one week prior to period
  • Current diagnosis of fibrocystic breast disease

Menopause

Do You Have… ?

  • Irregular menstrual cycle
  • Menstruation excessive or prolonged
  • Menstruation too frequent
  • Acne, worse at menses
  • Menses scanty or missed
  • Hysterectomy/ovaries removed
  • Dry skin, hair, vagina
  • Lackof interest in sex
  • Mood swings, irritable
  • Depression, anxiety, nervousness
  • Craving for sweets, binge eating
  • Headaches or dizziness
  • Painful intercourse
  • Sudden hot flashes
  • Spontaneous sweating
  • Shortnessof breath and/or heart palpitations
  • Unpredictable vaginal bleeding
  • Difficulty holding urine
  • Difficulty sleeping
  • Mental fogginess
  • Vaginal pain and/or itching
  • Thin, scant white vaginal discharge
  • Low back and/or hip pain
  • Breast tenderness, pain or tingling, prickling sensation
  • Easy bruising, loss of skin tone
  • Thinning armpit and pubic hair
  • Stopped menstruating
  • Breasts beginning to shrink, sag
  • Abnormal growth of hair above lip

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