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Hormonal Imbalance

Hormonal Imbalance

Hormonal Imbalance

- Step 1 of 3

PART 1

Are you running from task to task?

Yes
No

Do you feel jittery, unfocused, or moody when hungry?

Yes
No

Are you tired and wired?

Yes
No

Do you have sugar cravings( dinner feels incomplete without something sweet)?

Yes
No

Do you experience indigestion, acid reflux or ulcers?

Yes
No

Do you struggle to calm down and slow down?

Yes
No

Do you have pink or purple stretch marks on your belly or back?

Yes
No

Are you quick to get angry?

Yes
No

Have you experienced infertility or miscarriages?

Yes
No

Do you have a hard time getting over adversity or diseases ?

Yes
No

Do you experience hair loss?

Yes
No

Is it hard for you to fall asleep and/or stay asleep ?

Yes
No

Do you retain water (puffy face, fingers or feet)?)

Yes
No

Do you have memory lapses, especially when emotional?

Yes
No

Do you get frequent colds and flus?

Yes
No

Do you experience heart palpitations?

Yes
No

Do you have muffin top (a roll of body fat around your waistline?

Yes
No

Do you have skin condition such as eczema or thinning skin?

Yes
No

Do you have bone loss(osteopenia or osteoporosis)?

Yes
No

TOTAL POINTS SCORED

PART 2

Do you experience fatigue or burnout( do you have to use coffee to keep going)?

Yes
No

Do you crave salt?

Yes
No

Do you have low blood pressure?

Yes
No

Do you feel dizzy after getting up from a seated or lying position?

Yes
No

Do you see life and people in a negative way?

Yes
No

Do you cry for no good reason or become easily emotional?

Yes
No

Do you lose stamina, especially in the afternoon and evening?

Yes
No

Do you have a hard time getting out of bed, or do you need two cups of coffee to wake up?

Yes
No

Have your problem- solving skills decreased?

Yes
No

Has your tolerance to stress decreased?

Yes
No

Do you struggle to get over a simple cold, flu or infections?

Yes
No

Are your blood sugar levels low or unstable?

Yes
No

Is your sex drive lower?

Yes
No

Do you feel mildly depressed?

Yes
No

TOTAL POINTS SCORED

PART 3

Do you have headaches, especially around your period?

Yes
No

Have you had ovarian cysts, breast cysts, or endometriosis?

Yes
No

Are your legs itchy or restless, especially at night?

Yes
No

Have you had any miscarriages during the first trimester?

Yes
No

Have you experienced infertility or subfertility( you can’t hold on to pregnancy )?

Yes
No

Do you have heavy or painful periods?

Yes
No

Do you experience bloating, especially in the belly and ankle area, and /or water retention?

Yes
No

Are your breasts ever painful and/or swollen?

Yes
No

Have you had irregular periods and /or cycles that have become more frequent as you age?

Yes
No

Do you have hot flashes?

Yes
No

Are you irritable or anxious?

Yes
No

Do you have difficulty falling and/or staying asleep?

Yes
No

Do you have dry skin or skin that has lost its fullness?

Yes
No

Do you experience spotting in the middle of your menstrual cycle?

Yes
No

TOTAL POINTS SCORED

PART 4

Do you have spider or varicose veins?

Yes
No

Do you have any cellulite?

Yes
No

Are your period’s heavy?

Yes
No

Have you had breast or ovarian fibroids?

Yes
No

Do you experience irritability, mood swings or anxiety?

Yes
No

Do you get headaches or migraines, particularly before your period?

Yes
No

Are you fat around your hips?

Yes
No

Do you use birth control pills?

Yes
No

Have you experienced heavy bleeding or post-menopausal bleeding?

Yes
No

Do you experience bloating, puffing, or water retention?

Yes
No

Are your breasts ever enlarged or do they feel tender?

Yes
No

Do you have endometriosis or painful periods?

Yes
No

Do you have PMS and/or depression?

Yes
No

Do you sometimes cry for no good reasons?

Yes
No

Do you have trouble falling asleep?

Yes
No

Do you have gallbladder problems, or has your gallbladder been removed?

Yes
No

TOTAL POINTS SCORED

PART 5

Is your memory ever poor (‘why did I walk into this room?)?

Yes
No

Do you have night sweats and/or hot flashes?

Yes
No

Is your bladder leaky or overactive?

Yes
No

Do you feel emotionally fragile, especially when compared to year ago

Yes
No

Do you experience depression, anxiety, and/or lethargy (loss of enthusiasm)?

Yes
No

Do you have trouble falling and staying asleep?

Yes
No

Do your joints ache?

Yes
No

Have you lost interest in exercise?

Yes
No

Do you have bone loss or osteoporosis?

Yes
No

Have you experienced vaginal dryness, irritation, or loss of feeling?

Yes
No

Are your eyes, skin, and /or vagina dry?

Yes
No

Do you have a low sex drive?

Yes
No

Is sex painful?

Yes
No

Is your skin dry and saggy?

Yes
No

Is your skin thinning?

Yes
No

Are your breasts shrinking and sagging?

Yes
No

Have you experienced menopause?

Yes
No

Do you have ‘love handles’ or fat gain around your abdomen?

Yes
No

TOTAL POINTS SCORED

PART 6

Do you have acne?

Yes
No

Do you have oily skin and/or hair?

Yes
No

Have you lost hair on your scalp?

Yes
No

Do you have hair growth on your chin, upper lip, breasts, or stomach?

Yes
No

Have you experienced infertility?

Yes
No

Are your breasts shrinking and saggy?

Yes
No

Do you experience irritability or aggression or get easily agitated?

Yes
No

Have you gained fat around your belly?

Yes
No

Do you experience irritability or aggression or get easily agitated?

Yes
No

Have you gained fat around your belly?

Yes
No

Do you have crave sweets and/or carbohydrates?

Yes
No

Do you have fatty liver?

Yes
No

Are your armpits discolored (darker and thicker skin than normal)?

Yes
No

Are you hypoglycemic or hyperglycemic (low or high blood sugar levels)?

Yes
No

Do you experience depression and/ or anxiety?

Yes
No

Do you have ovarian cyst or PCOS?

Yes
No

Do you experience pain in the middle of your menstrual cycle?

Yes
No

Are you constantly hungry and/or has your appetite increased?

Yes
No

TOTAL POINTS SCORED

PART 7

Have you experienced muscle loss?

Yes
No

Have you experienced muscle weakness?

Yes
No

Have you gained weight, especially ‘soft fat’ around the waist?

Yes
No

Has your ratio of fat to muscle moved toward fat?

Yes
No

Do you lack confidence compared with previously?

Yes
No

Do you lack drive and assertiveness?

Yes
No

Is your libido low?

Yes
No

Are you tired?

Yes
No

Do you experience mood swings, depression, and/ or low mood?

Yes
No

Do you have difficulty concentrating?

Yes
No

Do you have bone loss or osteoporosis?

Yes
No

Does your skin sag?

Yes
No

Have you experienced hair loss?

Yes
No

TOTAL POINTS SCORED

PART 8

Have you lost any hair on your scalp?

Yes
No

Have you lost any hair from your eyebrows and/or eyelashes?

Yes
No

Have you gained weight despite a healthy diet and exercise?

Yes
No

Do you experience depression, anxiety and/or lethargy?

Yes
No

Do your eyelids flicker?

Yes
No

Are your hair, nails, and skin brittle or thinning?

Yes
No

Is your skin dry?

Yes
No

Do you have high LDL cholesterol levels?

Yes
No

Do you experience muscle or joint pains and caches?

Yes
No

Are you feeling constipated?

Yes
No

Do you feel tingling in your hands and/or feet?

Yes
No

Are your hands and/or feet cold?

Yes
No

Are you tired?

Yes
No

Do you experience ‘foggy brain’ (slow, thoughts, difficulty focusing) Have you experienced infertility?

Yes
No

Is your sex life lower than it was previously?

Yes
No

Is your thyroid enlarged?

Yes
No

Do you have a family history of thyroid problems?

Yes
No

Do you have hives?

Yes
No

Are there indents on the sides of your tongue when you stick it out?

Yes
No

TOTAL POINTS SCORED

PART 9

Do you still feel hungry even after a full meal?

Yes
No

Are you tired after a meal?

Yes
No

Do you crave sweets and carbohydrate all the time?

Yes
No

Are you tired throughout the day?

Yes
No

Do you experience extreme thirst or hunger?

Yes
No

Do you experience frequent or increased urinations?

Yes
No

Do you feel tingling sensations in your hands or feet?

Yes
No

Do you have dark patches on the back of your neck, groin, and/or armpits (acanthosis nigricans )?

Yes
No

Have you been diagnosed with type 2 prediabetes or diabetes?

Yes
No

Do you have cardiovascular problems?

Yes
No

Have you experienced vision changes and/or have you had cataracts?

Yes
No

Have you experienced infertility or irregular periods?

Yes
No

Have you experienced hair growth above the mouth or on the chin or nipples?

Yes
No

Do you have high LDL cholesterol, high triglycerides or high blood pressure?

Yes
No

Have you been diagnosed with fatty liver?

Yes
No

Is your hemoglobin A1c (HA1c) sugar marker higher than 5.4percent?

Yes
No

Is your insulin level higher than 15IU/ml?

Yes
No

Is your fasting glucose level higher than 90mg/dL?

Yes
No

TOTAL POINTS SCORED

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43 Kola Amodu Foreshore zone Magodo phase 2
Phone: +2349030057694

Oluwaseyi Aruleba, MD specialize in all aspects of integrative medicine, functional medicine, alternative medicine, hoilstic medicine, nutritional medicine, herbal medicine, stress reduction, pain management, anti-aging/ beauty and mindfulness. It is a wellness and hoilstic practice based in Lagos Nigeria since 2018. We see clients within and abroad.

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