Larned Psychology Menstrual Health Survey

Menstrual Health Survey

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Birth Date: *

DayMonthYear
What feelings, mood or emotional changes do you notice during the pre menstrual phase or during your menses?
What needs arise around your menses? How are they met? How are they unmet?
Are there any thoughts, themes or feelings that seem to be submerged during most of the month, but arise during the pre menstrual or menstrual phase?
How do the people close to you respond to your physical or emotional pain? Are you able to talk about it with them?
Have you ever felt dismissed regarding the pain and discomfort that might come from your menses?
How is your relationship to your body during and around menstruation? Do you feel closer or further away from your body?
What sensations occur leading up to and during your menses? How might this effect your day to day life? (e.g. bloating, digestive issues, desire for touch, sensitivity, pain, fatigue)
How was menses discussed at home growing up?
What do you wish someone would ask about regarding your menstrual health?
If you've been diagnosed by a physician, what is your diagnosis? If not, what gets in the way?
Should be Empty: