Women’s MyT Survey Your Name: Your Email: City: State: ZIP: Phone: 1. I have noticed a dramatic decrease in my energy levels. YesNo 2. For the most part, I have poor sleep quality. YesNo 3. I tend to experience night sweats and/or hot flashes. YesNo 4. I often find it difficult to lose weight. YesNo 5. I have noticed a loss of muscle mass in my body. YesNo 6. I tend to carry excess weight in my mid-section. YesNo 7. I have a decreased libido or loss of sexual desire. YesNo 8. I experience frequent feelings of anger/anxiety/depression. YesNo 9. I have had a hysterectomy. If yes, please specify the year: YesNo 10. I have had a tubal ligation. If yes, please specify the year: YesNo Enter the Following Digits