Unmasking PCOS: PCOS Symptom Awareness Survey

1
Provide the initials of your name. (example: J.A.G. for Juan A. Gomez). NOTE: This is only optional, you can leave it blank if you do not want to share your
2
What is your age?* This field is required.
3
Are you aware of the symptoms for Polycystic Ovarian Syndrome (PCOS)? ** This field is required.
Not at all aware
Slightly Aware
Somewhat Aware
Moderately Aware
Extremely Aware
4
Have you experienced having trouble gaining weight or losing weight? ** This field is required.
Yes
No
Not applicable. I haven't tried gaining or losing weight.
5
Does anyone in your family or relatives have a history of PCOS or is currently diagnosed with PCOS?* This field is required.
YESNO
6
Which of the following have you experienced for the past months?(Select all that apply)
Irregular periods / no periods at all
Excessive hair growth (hirsutism) - usually on the face, chest, back, or buttocks
Weight gain/obesity
Small pieces of excess skin on the neck or armpits (skin tags)
Thinning hair and hair loss from the head
Difficulty getting pregnant (because of irregular ovulation or no ovulation)
Polycystic ovaries
Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts/darkening of the skin
Oily skin or acne
Should be Empty: