What's your key hormone imbalance?

When it comes to your skin, which are you more prone to?
Really dry, flaky skin
Acne, especially around mouth/chin/jawline
Oily, sometimes with small pimples or blackheads
Acne, moreso on my cheeks or forehead
Sweating a lot
None of the above
In terms of thinking, memory & brain power, do you experience any of the following?
Foggy brain (hard to concentrate)
Poor memory
Lack of motivation to learn
None of the above
Do you experience (or have a recent history of) any of the following mental/emotional symptoms?
Depression
Anxiety
General nervousness
High anger
Mood swings
Panic attacks
None of the above
On average, what's your sleep quality like?
I find it hard to fall asleep
I get hot & sweaty overnight
I find it hard to stay asleep
I find it hard to wake up (aka not a morning person)
None of the above
Which of the following pre-menstrual symptoms do you experience, if any? (these are symptoms that begin before you period, and typically resolve once you start bleeding or shortly after)
Mood swings
Bloating
Acne
Sugar cravings
Salt cravings
Depression
Anxiety
Anger
Lots of crying
Changes to my skin/hair/nails
Sore breasts
Abdominal pain
None
A little intimate, but important: what's your general vaginal health like?
I experience recurrent thrush
I experience vaginal dryness
I have lots of cervical mucus or 'discharge'
None of the above
Keeping it intimate, what's your experience of libido & intimacy?
I have a high libido
I have a low libido
I have a fluctuating libido
I'm not relaxed enough to enjoy intimacy
I find penetrative intercourse painful
None of the above
When it comes to your general reproductive health, have you ever been diagnosed with or experienced...
Uterine fibroids
Endometriosis
Recurrent miscarriages
Polycystic Ovarian Syndrome
None of the above
Have you ever experienced any hair loss or thinning from your scalp?
Yes
No
Do you have excessive hair growth on your face, jawline, back or chest?
Yes
No
Unsure
Thinking about your physical body, do you experience...
General aches/pains
Fibromyalgia
Weight gain
Weight loss
Specific joint pain or mobility issues
Muscle weakness
Bone density loss or osteoporosis
None of these
In terms of general wellbeing, tick any of these that apply to you
Fatigue
High energy
Irritability
Low motivation
None
If you have had your thyroid hormones tested, were your test results out of range?
Yes
No
Haven't checked
Thinking about your blood sugar regulation, do you have...
High blood sugar
Low blood sugar
Intense sugar cravings
Fatigue after meals
A family history of diabetes
Not sure
What's your general stress response like?
Highly stressed - easy to stress out
Moderate & circumstantial
Low stress - hard to stress out
None of these options
Let's talk periods. How are your cycles?
Rhythmic and predictable, within every 25 to 35 days. Fairly normal
Irregular - I never know when to expect my period
I haven't had a period for more than 3 months
Short - I get my period every 25 days or less
Long - I get my period every 35 days, or more
Unsure
Do you experience period pain?
Yes - severe
Yes - moderate
Yes - mild
No period pain
Do you experience more than 1 day of spotting (very light coloured or brown discharge) before your period?
Yes
No
Do you experience heavy periods (e.g. Changing a pad or tampon more frequently than every 3 hours, having to empty your cup more than 3x per day, overnight flooding, etc.)
Yes
No
Past - not currently
Unsure
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