fbpx

Discover how stress is affecting your hormones.

 

I’m Dr. Danica Kampfe, an expert in Dr. Crawford’s Hormone Revitalization Method. Watch this video as I explain how to fill out the scoresheet and what to do if you score 20 or higher.

Adrenal and Hormone Imbalance Scoresheet

 

Instructions:  On a sheet of paper, quantify each question with 0, 1, 2 , or 3 (see below for range) and tally the total. Use the interpretation reference at the bottom of this page to read about what your score means. 

0 – Never

1 – Occasionally (1-4x monthly)

2 – Moderate in severity/moderately frequent (1-4x per week)

3 – Intense in severity & occurs frequently (4x per week)

 

1   I get dizzy or see spots when standing up rapidly from a sitting or lying position.
2   I urinate more frequently than others and may need to get up at night.
3   I feel as though I might faint or black out.
4   I have chronic fatigue
5   I have mitral valve prolapse or get heart palpitations.
6   I often have to force myself in order to keep going.
7   I have difficulty getting up in the morning.
8   I have low energy before the noon meal (approximately 11:00 a.m.)
9   I have low energy in the late afternoon between 3:00-5:00 p.m
10   I usually feel better after 6:00 p.m.
11   I often feel the best late at night because I get a “second wind.”
12   I have trouble getting to sleep.
13   I tend to wake early (approximately 3:00 to 5:00 a.m.) and have trouble getting back to sleep.
14   I have vague feelings of being generally unwell for no apparent reason.
15   I get swelling in the extremities, such as the ankles.
16   I need to rest after times of mental, physical, or emotional stress.
17   I feel more tired after exercise or physical, either soon after or the next day.
18   My muscles feel weak and heavy more than they should.
19   I have chronic tenderness in my back near the bottom of my rib cage.
20   I have a weak back and / or weak knees.
21   I have restless extremities.
22   I am allergic to many things, such as foods, animals, and pollens.
23   My allergies are getting worse.
24   I get bags or dark circles under my eyes, which may be worse in the morning.
25   I have multiple chemical sensitivities.
26   I have asthma or get regular bouts or bronchitis, pneumonia, or other respiratory infections.
27   I have dermatographism (a white line appears on my skin if I run my fingernail over it and persists for one minute).
28   I have an area of pale skin around my lips.
29   The skin on the palms of my hands and soles of my feet trends to be red/orange in color.
30   I tend to have dry skin.
31   I tend to get headaches and a sore neck and shoulders.
32   I am sensitive to bright light.
33   I frequently feel colder than others around me.
34   I have decreased tolerance for cold.
35   I have Raynaud’s syndrome (extremely cold hands/feet).
36   My temperature tends to be below normal when measured with a thermometer.
37   My temperature tends to fluctuate through the day.
38   I have low blood pressure.
39   I become hungry, confused, or shaky if I miss a meal.
40   I crave sugar, sweets, or desserts.
41   I use stimulants, such as tea or coffee, to get started in the morning.
42   I crave food high in fat and feel better with high-fat foods.
43   I need caffeine (chocolate, tea, coffee, colas) to get me through the day.
44   I often crave salt and/or foods high in salt, such as potato chips.
45   I feel worse if I eat sweets and no protein for breakfast.
46   I do not eat regular meals.
47   I eat fast-food often.
48   I am sensitive to pharmaceutical or nutritional supplements.
49   I have taken steroid medications for a long term or at high doses.
50   I have symptoms that improve after I eat.
51   I tend to be thin and find it difficult to put weight on.
52   I have feelings of hopelessness and despair or have been diagnosed with depression.
53   I lack motivation because I do not feel I have the energy to get things done.
54   I have decreased tolerance towards other people and tend to get irritated by them.
55   I get more than two colds or flus per year.
56   It takes me a long time to recover from illness.
57   I get rashes, dermatitis, eczema, psoriasis, or other chronic skin conditions.
58   I have an autoimmune disease.
59   I have fibromyalgia. 
60   I have had mononucleosis or been diagnosed with Epstein Barr virus.
61   I do not exercise regularly.
62   I have a history of large amounts of stress in my life.
63   I tend to be a perfectionist.
64   My health is negatively affected by stress
65   I tend to avoid stressful situations for the sake of my health.
66   I am less productive at work than I used to be.
67   My ability to focus mentally is generally impaired.
68   I tend to avoid stressful situations for the sake of my health.
69   I am less productive at work than I used to be.
70   My ability to focus mentally is generally impaired.
71   Stressful situations hinder my ability to focus.
72   Stress causes me to become overly anxious.
73   I startle easily.
74   It can take me days or weeks to recover from a stressful event.
75   I tend to get digestive disturbances when tense.
76   I tend to get unexplained fears and phobic.
77   My sex drive is very low or non-existent.
78   My relationships at work and/or home tend to be strained.
79   My life contains insufficient time for fun and enjoyable activities.
80   I have little control over my life and I feel “stuck.”
81   I tend to get addicted easily to drugs, alcohol, or foods.
82   I suffer from post-traumatic stress disorder.
83   I have or have had an eating disorder.
84   I have gum disease and/or tooth infections or abscesses.
85   I have symptoms of premenstrual syndrome (PMS)
86   My periods are irregular and/or affected by stress.
    Total Score (Level of adrenal and hormone imbalance)

 

 Interpretation:    

Under 20: Possibly no imbalance           

20-40: Mild imbalance with potential stage 1 adrenal fatigue; could benefit from adrenal and hormone balancing.                      

41-80: Moderate imbalance with potential stage 2 adrenal fatigue; would benefit significantly from hormone balancing.     

81-120: Serious imbalance with possible stage 2 or 3 adrenal fatigue; hormone balancing required for health improvement.                    

Above 120: Severe imbalance with possible stage 3 or 4 adrenal fatigue; hormone balancing required for getting your life back.

Stay In Touch

Sign up for our newsletter for the latest deals and health tips

Contact

Email : info@naturkurwellness.com
Phone : 206.762.4823
Fax : 206.458.6007