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 FEMALE QUESTIONNAIRE - PAGE 6(e) 

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This section deals with your periods.
635.  Do you suffer from anxiety related to your menstrual cycle?
No / don't know
Moderate
Severe
636.  Have you experienced breast tenderness, soreness or swelling associated with your cycle?
No / don't know
In the past only
Mild
Moderate
Major
637.  Do you suffer from depression during or before your period?
Don't know
No
Moderate
Severe
638.  Do you experience hot flashes and, if so, when do they occur?
Not applicable / don't know
No, I do not experience hot flashes
Yes, during or around time of period only
Yes, between periods only
Yes, both during and between periods
639.  Do you suffer from Premenstrual Syndrome (PMS)?
No / don't know
Minor
Moderate
Serious
Severe
640.  Do you suffer irritability related to your menstrual cycle?
No / don't know
Occasionally / moderate
Often / severe
641.  Water retention (edema) - do your ankles swell before menstruation?
No / don't know
Occasionally / moderately
Often / severely
642.  Are your menstrual cycles irregular?
No / don't know
Occasionally / moderately
Often / severely
643.  What is the average length of your menstrual cycle?
Very short - under 20 days
Short - 20 to 25 days
Normal - 26 to 30 days / don't know
Long - 31 to 35 days
Very long - over 35 days
644.  Do you have bleeding between periods?
Don't know
No
Occasionally / moderately
Often / severely
645.  How would you rate your average menstrual flow?
Don't know
Light
Normal / average
Heavy
Very heavy
646.  Have you experienced missed periods that are unrelated to pregnancy, breast feeding, menopause or birth control pill use?
No / don't know
Yes, but not in the last two years
I occasionally miss a period
I regularly miss a period or 1 to 2 in a row
My periods are infrequent or absent
647.  Do you have mood swings related to your menstrual cycle?
No / don't know
Occasionally / moderate
Often / severe
648.  Do you suffer from painful menstrual cramps?
Never had them / don't know
Probably had them/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem
Current major problem
649.  Do you have poor concentration during certain parts of your menstrual cycle?
No / don't know
Occasionally / moderate
Often / severe
650.  Do you have weight gain greater than 3 pounds (1.5kg) and / or abdominal bloating associated with your cycle?
Don't know
No
Weight gain
Abdominal bloating
Both
651.  Do you have a sugar, chocolate or carbohydrate craving associated with your cycle?
No / don't know
Occasionally / moderate
Often / severe

Add any additional information here for the questions above:

Please mention the question number(s) if possible.

 


 


GLOSSARY

Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.

Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.

Carbohydrates (Carbohydrate)
The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.

Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.

Crave (Craving, Cravings)
To have a strong desire for; to feel the need for.

Edema
Abnormal accumulation of fluids within tissues resulting in swelling.

Kilogram (kg, kgs, Kilogramme, Kilogrammes, Kilograms)
1000 grams, 2.2lbs.

Menopause (Menopausal)
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.

Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.

Premenstrual Syndrome (PMS)
PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.





























 

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