Please fill out the following quiz completely:

Do you feel tired and fatigued? :  Yes NO
Do you have a loss of clarity? :  Yes NO
Do you experience mood changes or irritability? :  Yes NO
Do you suffer from memory loss? :  Yes NO
Do you feel depressed? :  Yes NO
Do you suffer from bloating? :  Yes NO
Do you have breast tenderness? :  Yes NO
Are you losing sleep? :  Yes NO
Do you suffer from hot flashes? :  Yes NO
Do you have night sweats? :  Yes NO
Do you have high blood pressure? :  Yes NO
Do you have irregular periods? :  Yes NO
Do you suffer from vaginal dryness? :  Yes NO
Do you have Arthritis? :  Yes NO
Do you suffer from migraines? :  Yes NO
Have you experienced hair loss? :  Yes NO
Is it harder to reach climax? :  Yes NO
Do you have a decreased libido (sex drive)? :  Yes NO
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Email :
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