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.)
Fatigue
Stress
Lack of focus
Sleeplessness
Low mood/feeling down
Muscle and joint aches
Mood swings
Night sweats
Lower / Lack of sex drive
Hot flashes
Weight gain
Difficulty concentrating
Irritability
None of the above
Continue
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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