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Post or Peri-Menopausal Female Hormones

The female hormone complex is complicated and has very unique characteristics when compared to the male hormone complex.  Your sex hormones are constantly changing from the time you are born all the way through menopause and beyond.  The sex hormones play major roles in multiple organ systems in your body and when the sex hormones are not at adequate levels it can affect sleep, muscle mass, libido, hair, skin, your mood and a host of other different symptoms in addition to the above.  This quiz is designed to help determine if you could have Female Hormone Dysfunction.  The results are not diagnostic of dysfunction but will help direct you if you should seek further evaluation with a Qualified Medical Professional.

Sincerely,

Jon Skelton, MD

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Past Medical History for Sex Hormone Dysfunction

In this section we will assess your risk for Hormone Dysfunction due to Past Medical History

Question 2 of 17

Do you or a close relative (Mother, Grandmother, Sister) have a family history of Uterine, Endometrial, or Ovarian Cancer?

A

Yes

B

No

Question 3 of 17

Are you currently menopausal or peri-menoausal?

A

Yes

B

No

Question 4 of 17

Are you currently on any hormone replacement therapy?

A

Yes

B

No

Question 5 of 17

Have you had a hysterectomy?

A

Yes

B

No

Your Current Symptoms

In this section we will be asking you to rate how often you have symptoms associated with Hormonal Dysfunction. 

Answers will range from 0 which means rare/never to 3 which means nearly daily or more.  Only choose 1 answer.

Question 7 of 17

Since menopause  do you ever have uterine bleeding

A

0

B

1

C

2

D

3

Question 8 of 17

Hot Flashes

A

0

B

1

C

2

D

3

Question 9 of 17

Mental Fogginess

A

0

B

1

C

2

D

3

Question 10 of 17

Disinterest in sex 

A

0

B

1

C

2

D

3

Question 11 of 17

Mood swings

A

0

B

1

C

2

D

3

Question 12 of 17

Depression

A

0

B

1

C

2

D

3

Question 13 of 17

Painful Intercourse

A

0

B

1

C

2

D

3

Question 14 of 17

Facial Hair Growth 

A

0

B

1

C

2

D

3

Question 15 of 17

Increased vaginal pain, dryness, or itching 

A

0

B

1

C

2

D

3

Question 16 of 17

Acne

A

0

B

1

C

2

D

3

Question 17 of 17

Shrinking breasts 

A

Yes

B

No

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