Menopause Questionnaire
There are some error(s). Please see each marked section below.
Progress:
Thank you for completing this anonomous questionnaire - our aim is to make our information and support materials for women going through menopause as relevant as possible to your current needs. We greatly appreciate your feedback. In recognition of your help, we will donate $1.00 to the Canadian Cancer Society for each questionnaire returned.
1.
In what age group are you please?
Less than 45
Less than 45
45 - 50
45 - 50
51 - 55
51 - 55
Over 55
Over 55
2.
What is your current menopausal status?
Not yet at the 'change'- no / minor symptoms GO TO Q13
Not yet at the 'change'- no / minor symptoms GO TO Q13
Not yet at the 'change'- have symptoms GO TO Q13
Not yet at the 'change'- have symptoms GO TO Q13
At the 'change' - have symptoms
At the 'change' - have symptoms
At the 'change' - no / minor symptoms
At the 'change' - no / minor symptoms
Through the 'change'- no / minor symptoms GO TO Q13
Through the 'change'- no / minor symptoms GO TO Q13
3.
How did you confirm that you were menopausal?
Own interpretation of symptoms
Own interpretation of symptoms
Home menopause test
Home menopause test
Doctor consultation
Doctor consultation
Haven't confirmed
Haven't confirmed
Other
Other
4.
What symptoms are you experiencing? (tick all that apply)
Hot flushes
Hot flushes
Night sweats
Night sweats
Mood swings
Mood swings
Anxiety
Anxiety
Depressive mood
Depressive mood
Sleeplessness
Sleeplessness
Other - please state
Other - please state
No symptoms
No symptoms
5.
How are you currently managing your menopausal health?
Doing nothing
Doing nothing
Using a natural approach
Using a natural approach
Using a conventional medical approach, eg HRT (Hormone Replacement Therapy)
Using a conventional medical approach, eg HRT (Hormone Replacement Therapy)
Other
Other
6.
In your view how trustworthy is the information on the menopause from each of the following?
Very
Somewhat
Not
Doctor
Nurse
Pharmacist
Magazine
Internet
Relative
Friend
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