Question 1 of 5

What age range best describes you?

  • 35-40
  • 41-46
  • 47-54
  • 55+
Question 2 of 5

When was the last time you’ve had your period?

  • Within the last 3 months
  • Between 3-6 months
  • Between 6-12 months
  • No periods within the last 12 months or longer
Question 3 of 5

Which of the following best describes your period?

  • Regular every month: My periods are on time and I’ve noticed no changes in flow or duration.
  • Somewhat irregular: My periods are not always on time. Sometimes, they are late or early and I’ve noticed that the duration and flow tend to vary from my typical period.
  • Very irregular: Some months I don’t have a period at all and there are changes in duration and flow when my cycle does occur.
Question 4 of 5

Are you experiencing any of the following symptoms? (You can select more than one symptom.)

Question 5 of 5

Overall, how bothered are you by the symptoms you are experiencing?

  • Extremely bothered
  • Very bothered
  • Somewhat bothered

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