Let's Get to Know Your Current Experience

Let's Get to Know Your Current Experience

This short, confidential questionnaire is designed to help you better understand where you are in your perimenopause or menopause journey. Your responses will help us provide insights tailored to your unique experience because, managing this phase of life starts with understanding it. INSTRUCTIONS: For each question, select the option that best describes your experience.
Do you have irregular periods?*

No, periods are regularOccasionally irregularVery irregular or skipped periods
Score irregular periods
Are you in medical menopause?*

NoYes
Score medical meno or not
How often do you experience hot flashes or flushes?*

Rarely or neverOccasionally (a few times a week)Frequently (daily)
Score hot flashes or not
How is your sleep quality?*

Good, restful sleepSometimes trouble falling asleep or waking upFrequently sleep disturbances
Score sleep quality
Do you experience mood swings or irritability?*

Rarely or neverSometimesFrequently
Score mood swings
Are you noticing changes in your memory or concentration?*

No changeSlight forgetfullness or difficulty concentrationSignificant issues with memory or focus
Score on memory
Do you experience vaginal dryness or discomfort?*

NoOccasionallyFrequently
Score vaginal dryness
Are you experiencing decreased libido (sex drive)?*

No changeSlight decreaseSignificant decrease
Score decreased libido
Do you have weight changes or shifts in body composition?*

NoSlight changesSignificant weight gain or loss
Score weight changes
How often do you feel anxious or stressed?*

RarelySometimesFrequently
Score feeling anxious
Do you notice hair thinning or skin changes?*

NoSlight changesNoticeable thinning or skin issues
Score on hair and skin changes
Are you experiencing joint or muscle aches?*

NoOccasionallyFrequently
Score joint or muscle aches
How long have you been experiencing symptoms?*

Less than 6 months6-12 monthsOver a year
Score on how long symptoms
Do you experience night sweats?*

NoSometimesOften
Score on night sweats
Are you experiencing headaches or migraines more frequently?*

NoOccasionallyFrequently
Score on headaches or migraines
Just two (2) more questions...
Do you feel generally more fatigued than usual?*

NoSometimesAlways
Score on more fatigued
What is your age?
Total Score
Should be Empty:

Let's Get to Know Your Current Experience

Just two (2) more questions...