Symptoms of Menopause

Symptoms of Menopause
Email Address*
example@example.com
Name*
Age*
Country Of Residence*
I have not had a menstrual cycle in the last 12 months. (In menopause)*

YesNo
I had a hysterectomy (removal of the uterus) operation/surgery*

NoYesBoth ovaries were removedI don't knowOne ovary was removed
If you have answered "yes" to the question above, how many years ago did you have the surgery/operation?*
If you had a hysterectomy, what was the reason?*
Symptoms Of Menopause
I have hot flashes *

1

2

3

4

1 is Not at all, 4 is Extremely
I have night sweats*

1

2

3

4

1 is Not at all, 4 is Extremely
I have difficulty getting to sleep*

1

2

3

4

1 is Not at all, 4 is Extremely
I have difficulty staying asleep*

1

2

3

4

1 is Not at all, 4 is Extremely
I get heart palpitations or a sensation of butterflies in my chest or stomach*

1

2

3

4

1 is Not at all, 4 is Extremely
I feel like my skin is crawling or itching*

1

2

3

4

1 is Not at all, 4 is Extremely
I feel more tired than usual*

1

2

3

4

1 is Not at all, 4 is Extremely
I have difficulty concentrating*

0

1

2

3

4

0 is Not at all, 4 is Extremely
My memory is poor*

0

1

2

3

4

0 is Not at all, 4 is Extremely
I am more irritable than usual*

0

1

2

3

4

0 is Not at all, 4 is Extremely
I feel more anxious than usual*

0

1

2

3

4

0 is Not at all, 4 is Extremely
I have more depressed moods*

0

1

2

3

4

0 is Not at all, 4 is Extremely
I am having mood swings*

0

1

2

3

4

0 is Not at all, 4 is Extremely
I have crying spells*

0

1

2

3

4

0 is Not at all, 4 is Extremely
I have headaches*

0

1

2

3

4

0 is Not at all, 4 is Extremely
I need to urinate more often than usual*

0

1

2

3

4

0 is Not at all, 4 is Extremely
I leak urine

1

2

3

4

1 is Not at all, 4 is Extremely
I have pain or burning when urinating*

0

1

2

3

4

0 is Not at all, 4 is Extremely
I have bladder infections*

1

2

3

4

1 is Not at all, 4 is Extremely
I have uncontrollable loss of stool or gas*

1

2

3

4

1 is Not at all, 4 is Extremely
My vagina is dry*

1

2

3

4

1 is Not at all, 4 is Extremely
I have vaginal itching*

1

2

3

4

1 is Not at all, 4 is Extremely
I have an abnormal vaginal discharge*

1

2

3

4

1 is Not at all, 4 is Extremely
I have vaginal infections*

1

2

3

4

1 is Not at all, 4 is Extremely
I have pain during intercourse*

1

2

3

4

1 is Not at all, 4 is Extremely
I have bleeding after intercourse*

1

2

3

4

1 is Not at all, 4 is Extremely
I lack desire or interest in sexual activity*

1

2

3

4

1 is Not at all, 4 is Extremely
I have difficulty achieving orgasm*

1

2

3

4

1 is Not at all, 4 is Extremely
My opportunity for sexual activity is limited*

1

2

3

4

1 is Not at all, 4 is Extremely
My stomach feels like it's bloated or I've gained weight*

1

2

3

4

1 is Not at all, 4 is Extremely
I have breast tenderness*

1

2

3

4

1 is Not at all, 4 is Extremely
I have joint pains*

1

2

3

4

1 is Not at all, 4 is Extremely
Total Score
About Menopause and Hormone Therapy
How do you view menopause?*

Positively. For example, menopause means no more periods and no more worry about contraception. Menopause marks a new life phase.Negatively. For example, menopause means a loss of fertility and loss of youth.Other
What concerns you about menopause?*
What are your current views regarding hormone therapy for menopause?*

Positive. Hormone therapy is appropriate for some women.Negatively. I don't support the use of hormone therapy.
What concerns you most about hormone therapy for menopause?*
How would you rate your knowledge about menopause?*

Very goodFairModerately goodLittle knowledge
How do you get your information about menopause? (Mark all that apply.)*

BooksInternetMagazinesFriendsTVHealthcare Providers
You will receive your total symptom score by email after you complete this questionnaire. We value your privacy. Your personal information will not be shared or sold to any individual or company. However, your responses may be used as a survey result to discuss common symptoms experienced by women.

The questions have been adapted from the Menopause Health Questionnaire of the North American Menopause Society.
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Symptoms of Menopause

Symptoms Of Menopause

About Menopause and Hormone Therapy