Women’s MyT Survey Your Name: *Your Email: *City: *State: *ZIP: *Phone: *1. I have noticed a dramatic decrease in my energy levels.YesNo2. For the most part, I have poor sleep quality.YesNo3. I tend to experience night sweats and/or hot flashes.YesNo4. I often find it difficult to lose weight.YesNo5. I have noticed a loss of muscle mass in my body.YesNo6. I tend to carry excess weight in my mid-section.YesNo7. I have a decreased libido or loss of sexual desire.YesNo8. I experience frequent feelings of anger/anxiety/depression.YesNo9. I have had a hysterectomy. If yes, please specify the year:YesNo9. I have had a hysterectomy. If yes, please specify the year:10. I have had a tubal ligation. If yes, please specify the year:YesNo9. I have had a hysterectomy. If yes, please specify the year: Send
