Menopause Survey

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* 1. What year were you born?

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* 2. Ethnic/cultural background (may select multiple):

White

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Indigenous

Another race

Other (please specify)

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* 3. What type of setting do you live in?

Urban

Suburban

Rural

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* 4. How tall are you?

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* 5. How much do you weigh (in pounds)?

600

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 6. How old were you when you had your first period?

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 7. Was/is your monthly period predictable within a couple days?

Yes

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* 8. Did/do you experience premenstrual syndrome (PMS)? For example, acne, mood swings, irritability, anxiety, etc.

Yes

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* 9. Did/does your monthly period impact your normal activities (e.g. not going to work, skipping plans with friends)?

Always

Usually

Sometimes

Rarely

Never

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* 10. Was/is your period:

Heavy

Medium

Light

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* 11. Have you ever been diagnosed with a menstrual disorder?

Yes