Menopause Survey


    Under 4040 - 4445 - 4950 - 5455 – 60Over 60


    EmployedUnemployedSelf-employed


    MarriedDivorcedSingleIn a relationship


    YesNo


    YesNoDon't know


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    Under 4040 - 4445 - 4950 - 5455 – 60Over 60


    YesNo


    YesNo


    YesNo


    YesNoNot Applicable


    YesNoNot Applicable


    YesNoNot Applicable


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    YesNo


    None1 - 5 days6 - 12 daysMORE than 12 days


    YesNoNot Applicable


    YesNoNot Sure


    YesNo


    YesNoNot Applicable


    YesNo


    YesNo


    YesNo


    YesNoNot Applicable


    YesNo

    MENOPAUSE_PACK


    YesNo


    YesNo


    Hot FlushesNight SweatsBrain FogPalpitationsAnxietyIrritabilityLow Mood/DepressionWeight GainInsomniaFatigueAching bonesThinning hairDry skinVaginal DrynessPainful sexStiff JointsLoss of LibidoIBS


    YesNoMaybe


    YesNoMaybe


    YesNo


    YesNo


    YesNo


    YesNo