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1. Fatigue or lethargy ____________________________________________________
2. Feeling or being "drained" ______________________________________________
3. Poor memory ________________________________________________________
4. Feeling "spacey" or "unreal" ____________________________________________
5. Inability to make decisions _____________________________________________
6. Numbness, burning or tingling ___________________________________________
7. Insomnia ____________________________________________________________
8. Muscle aches ________________________________________________________
9. Muscle weakness or paralysis __________________________________________
10. Pain and/or swelling in joints ___________________________________________
11. Abdominal pain _____________________________________________________
12. Constipation ________________________________________________________
13. Diarrhea ____________________________________________________________
14. Bloating, belching or intestinal gas ______________________________________
15. Troublesome vaginal burning, itching or discharge __________________________
16. Prostatitis __________________________________________________________
17. Impotence __________________________________________________________
18. Loss of sexual desire or feeling _________________________________________
19. Endometriosis or infertility _____________________________________________
20. Cramps and/or other menstrual irregularities ______________________________
21. Premenstrual tension _________________________________________________
22. Attacks of anxiety or crying ____________________________________________
23. Cold hands or feet and/or chilliness _____________________________________
24. Shaking or irritable when hungry ________________________________________
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