1) Sugar, starch, or salt cravings Yes No 2) Difficulty losing weight, even with diet and exercise Yes No 3) Hair loss Yes No 4) PMS (breast tenderness, bloating, mood swings, etc.) Yes No 5) Issues falling or staying asleep Yes No 6) Hypoglycemia or symptoms of blood sugar imbalance like shakiness, weakness, or irritability Yes No 7) Ab fat Yes No 8) Hot flashes or night sweats Yes No 9) Memory loss Yes No 10) Anxiety or depression Yes No 11) Skin that has lost its luster or tone Yes No 12) A low libido Yes No 13) Water retention Yes No 14) Fatigue Yes No 15) A loss of motivation or drive Yes No

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