Menopausal Wellness Check

In the last few months, how do you mostly feel from inside?* This field is required.Tick all the moods that feel true for you — sometimes more than one can happen together.

I feel sad without any clear reason

I get easily irritated or angry, mostly at family

I feel anxious or fearful inside

I feel lazy or without motivation

I often feel blank or forgetful

I feel mostly cheerful and positive

When you feel sad, what helps or makes it worse?* This field is required.Some women prefer being alone when sad, others want comfort but don’t feel better even after it. How is it for you?

I feel better when someone consoles me 🤗

I feel worse when someone consoles me, I just want to be left alone 😔

I don’t share, I keep everything inside 🧍‍♀️

Nothing helps, I feel indifferent or blank 😶

When you get angry, how does it usually come out?* This field is required.Anger can come out suddenly or stay bottled up inside. How does it show up in you these days?

I shout or scold quickly, especially at family members 😡

I become sharp-tongued, cutting, or sarcastic 🗡️

I don’t express it, I just bottle it inside 😶

I cry easily instead of shouting 😢

My anger goes away quickly, I don’t hold it for long 🌿

When forgetfulness troubles you, what do you miss most often* This field is required.Memory lapses are common in menopause. Which of these feels familiar?

Everyday household tasks or chores 🧹

Words while speaking, or names of people/things 🗣️

Where I kept things, I misplace items often 🔑

Important work commitments or responsibilities 📅

Do you ever cry or laugh suddenly without control?Sometimes women find themselves crying or laughing suddenly, without a big reason. Has this happened with you?

I cry very easily 😢

I laugh suddenly at small things 😅

No, mostly balanced 🙂

Do small things affect you more these days?* This field is required.Little things may hurt more than before. How would you describe your sensitivity now?

Yes, very much — even little things hurt me 💔

Sometimes, but I manage 🌿

Not really 🙂

Which of these body changes trouble you most?* This field is required.Think about the last few months. What changes in your body have you noticed that bother you most often? You can tick more than one.

Sudden hot flushes or heat in face/body

Night sweats / cold sweats

Disturbed or broken sleep

Joint pains or stiffness

Weight gain around belly area

Vaginal dryness or discomfort

Pain during intimacy (dyspareunia)

Burning or pain during urination (dysuria)

Itching / skin irritation (pruritus)

Hair fall, dry skin, or dullness

When do your hot flushes mostly happen?* This field is required.Hot flushes may come anytime — some women feel them more in the daytime, some at night, or around meals. When do yours usually bother you?

Daytime

Night

Around meals

What usually wakes you up at night?* This field is required.Sleep can break for different reasons — sudden heat, sweating, anxious thoughts, or discomfort in the body. What is most common for you?

Heat or sweating

Worrying thoughts

Pain or discomfort

Where do you feel the pain more?* This field is required.Menopause can bring stiffness or pain in different parts. Tick the one that fits you best.

Back and hips

Knees

General stiffness all over

Have you noticed any change in your sexual desire?* This field is required.Many women notice their interest in intimacy changes. Which option feels closest to you?

Same as before

Increased

Decreased

Do you also feel discomfort during intimacy?* This field is required.Dryness can sometimes cause pain or reduce interest. How does it feel for you?

Yes, with pain

Yes, with lack of desire

No, dryness only

How is your energy level during the day?* This field is required.Think about your usual day — when do you feel most active or most drained?

I feel weak and tired all day

I feel fresh in morning but energy drops after meals

I feel active only in evening

I feel okay throughout the day

Any digestion or urinary changes you notice?* This field is required.Hormonal shifts can affect digestion and bladder health too. Tick all that apply to you.

Gas or bloating

Acidity or burning in stomach

I crave sweets more often

I crave salty food more often

Unusual vaginal discharge

Stress incontinence (urine leaks with cough/sneeze/laugh)

No major issues

Which is your MAIN concern these days?* This field is required.Tick the problems that disturb you most often or feel hardest to handle.

Hot flushes and sweating

Mood swings / irritability

Headaches or migraines

Vaginal dryness or discomfort

Pain during intimacy

Heavy bleeding or irregular menses

Joint pains or stiffness

Sleep problems

Palpitations (sudden fast heartbeat)

Others (not listed)

When do your headaches usually get worse?* This field is required.Headaches can come for different reasons — heat, stress, or hormone shifts. When do yours feel strongest?

In sun or heat

Before periods

During emotional stress

How would you describe your bleeding pattern?* This field is required.Periods can change in many ways during menopause. Which description fits you best?

Sudden gushing, dark blood

Continuous with weakness

Spotting on and off

What kind of sleep problem troubles you most?* This field is required.Sleep can be disturbed in many different ways. Which is closest to your experience?

Difficulty falling asleep

Waking up often at night

Waking up very early in morning

Overall, how strong are your current problems?* This field is required.This helps me understand how much your symptoms affect your daily life.

Mild — I can manage daily life

Moderate — sometimes it disturbs daily life

Severe — every day feels disturbed

How much are your daily work or activities affected by your health right now?* This field is required.Menopause sometimes affects energy, focus, or daily routine. How much has it changed your day-to-day life?

Not at all

Sometimes I feel tired but continue

I lose interest / feel fatigued often

I do less work than before

I have stopped or reduced work because of health

What’s your full name? ✍️* This field is required.Your name will be used to prepare your personalised 21-days kit.

First Name

Last Name

What is your age group?* This field is required.Helps me align your kit with your life stage.

What is your occupation?* This field is required.Knowing your work helps me understand your daily routine and stress levels.

In which CITY are you currently living? 🏡* This field is required.Your City's name needed to customise recommendations in your kit.

Your WhatsApp number 📱* This field is required. I’ll use this to share updates and your 21-days kit directly.

Your WhatsApp number 📱