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Hormones?!
Check all that apply to you
Acne
Irregular periods
Loss of libido
Painful periods
Endometriosis
Insomnia
Dark circles under eyes
Sore throat/loss of voice
Hives/rashes/dry skin
Excessive sweating
Frequency urinary infections
Vaginal dryness
Diarrhea/constipation
Heartburn
Stomach/intestinal pain
Joint aches
Weight issues
Water retention
Mood swings
Depression
Facial hair
Hair loss
PMS
Heavy periods
PMDD
Headaches
Dry eyes
Stuffy nose/Hay fever
Frequentlyneed to clear throat
Hot flashes
Breast tenderness
Urinary incontinence
Irregular heartbeat
Bloated
Belching/passing gas
Fatigue
Craving certain food
Compulsive eating
Poor memory/concentration
Anxiety/nervosness
Anger/irritability
Excessive body hair
Difficulty getting pregnant
Age
*
18 to 26
27 to 34
35 to 44
45 to 50
51 to 60
60+
Birth control
*
Yes
No
Previous diagnosis of PCOS, endometriosis, infertility?
*
Yes
No
Name
Email
SUBMIT
Your personal hormone assessment will be emailed to you!
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