How old are you? Under 35 35-45 Over 45 None How regular are your periods? Very regular Sometimes irregular Becoming more irregular over time None Do you experience mood swings or irritability? Mostly just before my period Occasionally, but not tied to my period Frequently and unpredictably None How is your sleep quality? Generally good, except before my period Occasionally disrupted Frequently disrupted, with night sweats or insomnia None Do you experience hot flashes or night sweats? No, never Rarely Frequently None How is your energy level? Good, except during PMS Fluctuates, but not too extreme Often fatigued and low energy None Do you experience breast tenderness? Only before my period Occasionally, unrelated to my cycle Often, regardless of my cycle None How are your periods? Normal flow and duration Sometimes heavier or lighter than usual Very heavy or very light, unpredictable None Do you experience vaginal dryness? No Occasionally Yes, frequently None How are your cognitive functions (memory, focus)? No issues Occasionally forgetful Frequently experiencing “brain fog” None 1 out of 2 Name Email Phone Time's up
