Do you skmoke or vape tabacco?
Do drink alcohol?
On a scale of 1-5 (1 being the lowest and 5 being the highest), how do you rate the fallowing aspects
Than those of most people, would you say that your eating habits are:
How would you describe your overall quielity life
How many periods did you have in the last 12 months?
What was the date of your last mestrual period? Please use the best estimate
Have you had an ovary removed?
---Yes, oneYes, twoNever
Have you had your uterus removed (hysterectomy)?
Do any of the following apply to you?
I am postmenopausal due to any reason other than naturally occuring menopause.I am using birth control.I am using menopausal hormone therapy.I have a medical condition or procedure that caused my period to be irregular or stop.My periods have always been irregular.I am pregnant or breastfeeding.None of these options apply to me.
Which of the following symptoms are you experiencing at this time? Please rate the symptos on a scale from 1 to 5 (1 being none and 5 being very severe)
Hot flashes and sweating
Physical and mental exhaustion
Joint and muscular discomfort
Pain during sex
Are you participating in any of the following studies?
Mayo Clinical Digital Menopause Management Study.None of these options apply to me.
1. What do you know about menopause?
2. Can you describe the symptoms of peri and menopause?
3. What does your partner/family member living with you know about it?
4. If you are experiencing symptoms, what impact do the symptoms have on your life? Name the top 3 things that bother you
5. Where do you get information about your health (specifically menopause) (physical, mental) (explore trust)
6. When you hear perimenopause and menopause, what words come to mind?
7. How would you describe the information your health care provider shares with you regarding menopause? (if applicable)
8. What products or services would you like to have access to in order to help you manage your symptoms?
9. If there was a one stop shop where you could learn or get support- where would it be (can be virtual or physicalI)
10. Would you pay out of pocket for tools or support or services not provided by the public health care system?
11. What brands do you associate with menopause?
12. What are your favourite brands?
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