ADRENAL HEALTH ASSESSMENT

 

The Hypothalamus, pituitary, adrenal (HPA) axis is the body’s central stress response system. This questionnaire is designed to help assess the degree of possible dysfunction within this system.

Answer each question carefully. There are no right or wrong answers. For each question, please indicate the response option you feel best answers the question.

1. Do you have difficulty awakening from sleep in the morning, often hitting the snooze button multiple times?

2. Do you need coffee to get going in the morning?

3. Have you recently gained weight, especially around your midsection?

4. Do you feel like you get every cold and bug that is going around or that your immune system is shot?

5. Do you have more difficulty dealing with stress and deadline pressure than you used to?

6. Do you have a lack of interest in sex?

7. Do you frequently feel lightheaded upon standing quickly?

8. Do you feel depressed?

9. Do you struggle with poor memory or “brain fog”

10. Do you feel especially tired in the mornings and afternoons between 3-5 p.m.?

11. Do you feel the need to snack or eat frequently to maintain normal blood sugar levels?

12. Do you crave salty foods?

13. Do you crave sweet foods?

14. Do you feel extremely tired between 7-10 p.m. but get a second wind if you stay up later?

15. If you are female, do you struggle with PMS symptoms (such as heavy bleeding, moodiness, and fatigue) during your menstrual cycle? If you are male, do you feel like your stamina, energy, and ability to maintain muscle have decreased?

16. Do you frequently have pain in the upper back or neck for no apparent reason?

17. Do you have trouble falling or staying asleep?

18. Do you notice an improvement of symptoms when your stress levels are lower, such as during a vacation or time away from work?

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