Step 2 of 4
Section 2: Symptom Severity (Past 4 Weeks)
Select the severity level for each symptom:
None
,
Mild
,
Moderate
,
Severe
.
A. Vasomotor & Physical Symptoms
Hot flashes (daytime)
Select Severity
None
Mild
Moderate
Severe
Night sweats
Select Severity
None
Mild
Moderate
Severe
Chills or cold sweats
Select Severity
None
Mild
Moderate
Severe
Heart palpitations or racing heart
Select Severity
None
Mild
Moderate
Severe
Joint pain / stiffness
Select Severity
None
Mild
Moderate
Severe
Muscle aches or weakness
Select Severity
None
Mild
Moderate
Severe
Headaches / migraines
Select Severity
None
Mild
Moderate
Severe
Dizziness or vertigo
Select Severity
None
Mild
Moderate
Severe
Tingling or numbness in hands/feet
Select Severity
None
Mild
Moderate
Severe
Dry or itchy skin, hair thinning, brittle nails
Select Severity
None
Mild
Moderate
Severe
B. Sleep & Fatigue
Difficulty falling asleep
Select Severity
None
Mild
Moderate
Severe
Frequent night waking
Select Severity
None
Mild
Moderate
Severe
Waking too early
Select Severity
None
Mild
Moderate
Severe
Daytime fatigue
Select Severity
None
Mild
Moderate
Severe
Feeling physically exhausted
Select Severity
None
Mild
Moderate
Severe
← Previous
Save & Continue →