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1

Are you Menopausal?* This field is required.How do I know if I’m menopausal? - If you still get periods, answer “No.” - If your last natural period was more than a year ago, or due to medication or surgery that stopped ovarian function, answer “Yes." - If you don’t have a “natural” cycle (eg. due to the pill or IUD, a hysterectomy or endometrial ablation) and are 50 or younger, answer “No.” If you are 51 or older, answer "Yes."

Yes

No

2

Did you have a natural, surgical or medical menopause before age 45?* This field is required.

Yes

No

3

Do you have significant symptoms of peri/menopause?* This field is required.eg. Hot flushes, sweats, mood changes, worsening sleep issues, brain fog or difficulties, aches and pains, vaginal dryness or pain, loss of libido, urinary issues.

Yes

No

4

Do you have risk factors for osteoporosis? (very low bone density)* This field is required.eg. low calcium diet, chronic or autoimmune disease, low impact fractures, long term steroid medications, low BMI, sedentary lifestyle, family history, or prolonged loss of periods.

Yes

No

5

Do you have risk factors for Heart Disease?* This field is required.eg. high body fat, smoking, low physical activity, high blood pressure, family history, diabetes or pre-diabetes, high cholesterol, high junk food intake or serious past cardiovascular issues.

Yes

No

6

Do you have risk factors for Dementia?* This field is required. eg. high body fat, smoking, low physical activity, high blood pressure, family history, diabetes or pre-diabetes, high cholesterol, high junk food intake or serious past cardiovascular issues. or depression, low social contact, multiple medications/drugs, past head injury, boring work, hearing impairment, sleep deprivation, family history dementia

Yes

No

7

Do you average less than 6.5 hours of sleep per night?* This field is required.

Yes

No

8

Is anxiety, depression or mood impairing your function?* This field is required.

Yes

No

9

Do you experience sexual dryness, pain or low libido?* This field is required.

Yes

No

10

Do you have bladder urgency, leakage or frequency?* This field is required.

Yes

No

11

Name* This field is required.

12

Email* This field is required.Add your email to receive your results and information about what they mean:

13

Calculated scoreYes = 5 No = 0