Menopause Hormone Clarity Tool

Menopause Hormone Clarity Tool

Instructions: Review each section and circle any symptom experienced in the past six months. Then total your answers at the end of each section.

Estrogen Excess Pattern

Fluid & Weight Changes

Bloating or water retention

Rapid weight gain in hips, thighs, or belly

Breast & Reproductive

Breast tenderness or enlargement

Fibroids or endometriosis

Fibrocystic breasts or clotting periods

Heavy or postmenopausal bleeding

Mood & Neurological

PMS, mood swings, anxiety, or depression

Weepiness or emotional sensitivity

Migraines or headaches

Insomnia or brain fog

Skin & Circulatory

Facial flushing or rosacea

Digestive & Liver/Gallbladder

Gallbladder issues

Sexual Health

Reduced libido

Total YES answers *

Stress Hormone Pattern

Vasomotor Symptoms

Hot flashes or night sweats

Sleep & Energy

Poor sleep or night waking

Reduced stamina

Cognitive & Mood

Memory lapses or brain fog

Emotional sensitivity or depression

Mood dips at night

Genitourinary Health

Bladder urgency or infections

Recurrent UTIs

Vaginal dryness or painful sex

Sexual Health

Low libido or arousal

Skin, Hair & Tissue

Wrinkles, thinning skin, or hair loss

Dry eyes, skin, or tissues

Musculoskeletal

Joint pain or stiffness

Bone loss or injuries

Total YES answers *

Total YES answers

Adrenal Energy Pattern

Energy & Fatigue

Fatigue or burnout

Morning fatigue that improves later

Afternoon energy crash (2–5 pm)

Crashes after mild activity

Dependence on caffeine

Mood & Stress Resilience

Feeling overwhelmed by stress

Low stress tolerance

Crying easily or chronic negativity

Sleep

Insomnia between 1–4 am

Cognitive Function

Poor focus or problem-solving

Brain fog relieved by rest or food

Immune & Recovery

Frequent infections or slow healing

Recurrent lingering infections

Asthma, allergies, or chronic cough

Circulation & Blood Pressure

Low blood pressure

Dizziness when standing

Cold hands or feet

Metabolic & Appetite

Low or unstable blood sugar

Salt cravings

Nausea or poor morning appetite

Digestive & Physical Signs

Digestive upset or loose stools

Muscle or joint weakness

Easy bruising or varicose veins

Dark circles under eyes

Excess sweating

Total YES answers *

Total YES answers

Adrenal Energy Pattern

Sleep & Nervous System

Trouble falling or staying asleep

Restless legs at night

Anxiety or restlessness

Mood & Emotional Regulation

Mood swings or irritability

Reproductive Cycle

Irregular or more frequent cycles

Heavy or painful periods

Spotting before period

Miscarriage history

Infertility

Breast & Pelvic Health

Breast pain or swelling

Ovarian, breast, or uterine cysts

Physical Symptoms

Bloating or fluid retention

Poor hair growth

Clumsiness or poor coordination

Sexual Health

Low libido

Vasomotor Symptoms

Worsening hot flashes or night sweats

Head & Neurological

Headaches or migraines

Total YES answers *

Total YES answers

Androgen (Testosterone) Pattern

Skin & Hair

Facial or body hair growth

Acne or oily skin

Thinning scalp hair

Skin tags

Metabolic

Blood sugar instability or insulin resistance

Abdominal weight gain

Darkened skin folds

Mood & Behavior

Aggression, irritability, or anxiety

Reproductive

Irregular or absent cycles

Ovarian cysts or PCOS

Infertility

Physical Changes

Voice deepening

Total YES answers *

Total YES answers

Thyroid Pattern

Metabolism & Weight

Unexplained weight gain

High cholesterol

Energy & Cognition

Fatigue or sluggish thinking

Depression or low motivation

Temperature & Circulation

Cold intolerance

Slow heart rate

Skin, Hair & Nails

Hair loss (including outer eyebrows)

Dry skin, brittle nails, or coarse hair

Puffy face or eyelids

Digestive

Constipation

Musculoskeletal & Neurological

Muscle cramps or numbness

Reproductive & Sexual Health

Low libido

Structural/History

Goiter or thyroid history

Hoarse voice

Fluid retention or swelling

Total YES answers *

Total YES answers

Blood Sugar & Insulin Pattern

Metabolic Markers

Elevated fasting insulin or triglycerides

High blood pressure

Weight & Body Composition

Central weight gain

Apple-shaped body fat

Appetite & Energy

Sugar cravings or intense hunger

Fatigue after eating carbohydrates

Cognitive

Brain fog or poor concentration

Glucose Regulation

Difficulty losing weight

Increased thirst or urination

Neurological

Tingling in hands or feet

Reproductive History

History of miscarriage or infertility

Elevated testosterone

Total YES answers *

Total YES answers

First Name

Last Name

Email *

Phone

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