Hormone Imbalance Forms Women Symptom Checklist for WOMEN Use each of the following checklists to determine sign & symptoms of hormone imbalance and help you choose the appropriate profile Category 1: Basic Hormone Imbalance Mark which of the following factors/symptoms are present and/or persist over time. Hot flashesHeart palpitationsHeavy mensesFibrocystic breastsLow libido/ decreased sexual function Mood Swings (PMS)Cystic ovariesFoggy ThinkingIrritabilityUterine fibroids Urinary incontinenceVaginal drynessWeight gainIncreased body/ facial hairAcne Night sweatsHeadachesDepressed moodBone loss Category 2: Adrenal Hormone Imbalance Mark which of the following factors/symptoms are present and/or persist over time. Aches and painsSleep disturbancesChronic health problemsLow blood sugar Weight gainDepressionEvening fatigueHistory of steroid usage Morning fatigueAnxietyAllergiesBone loss Food CravingsSusceptibility of infectionsAutoimmune diseaseDiabetes/ prediabetes Category 3: Thyroid Hormone Imbalance Mark which of the following factors/symptoms are present and/or persist over time. Aches and painsDry skinFatigueHeart palpitationsConstipation AnxietyCold hands and feetFoggy thinkingLow LibidoThinning hair Brittle NailsHeadachesWeight gainInability to lose weightMenstrual Irregularities DepressionFeeling cold all the timeSleep disturbancesElevated CholesterolInfertility Category 4: Cardiometabolic Risk Mark which of the following factors/symptoms are present and/or persist over time. History of smokingHigh blood sugarHigh blood pressure Weight gainSugar CravingsFatigueLow Physical Activity Heart disease or family history of heart diseaseDiabetes or family history of diabetesWaist size greater than 35 inchesElevated triglycerides If you checked symptoms in all four categories, the suggested test profiles are: MINIMUM: Female Blood Profile II (Blood Spot) PREFERRED: Comprehensive Female Profile I or II(Saliva/Blood Spot) and CardioMetabolic Profile (Blood Spot) If you checked symptoms ONLY in Category 1, the suggested test profiles are: MINIMUM: Female Blood Profile I (Blood Spot) or Female/Male Saliva Profile I (Saliva) PREFERRED: Comprehensive Female Profile I or II(Saliva/Blood Spot) If you checked symptoms ONLY in Category 2, the suggested test profiles are: MINIMUM: Adrenal Stress Profile (Saliva) PREFERRED: Comprehensive Female Profile I or II(Saliva/Blood Spot) If you checked symptoms ONLY in Category 3, the suggested test profiles are: MINIMUM: Essential Thyroid Profile (Blood Spot) PREFERRED: Comprehensive Female Profile I or II(Saliva/Blood Spot) OR Comprehensive Thyroid Profile(Blood Spot/Dried Urine) plus Female/Male Saliva Profile III (Saliva) If you checked symptoms ONLY in Category 4, the suggested test profiles are: MINIMUM: CardioMetabolic Profile (Blood Spot) PREFERRED: CardioMetabolic Profile (Blood Spot) plus Female/Male Saliva Profile III(Saliva)
