Female Questionnaire - Page 4(i)

Do you suffer from anxiety related to your menstrual cycle?

No / don't know
Moderate
Severe

Do you experience breast tenderness, soreness or swelling associated with your cycle?

Do you suffer from depression during or before your period?

Don't know
No
Moderate
Severe

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

Do you suffer from Premenstrual Syndrome (PMS)?

Do you suffer irritability related to your menstrual cycle?

No / don't know
Occasionally / moderate
Often / severe

Water retention (edema) - do your ankles swell before menstruation?

No / don't know
Occasionally / moderately
Often / severely

Are your natural menstrual cycles irregular? In other words, does the cycle length and/or the amount/duration of bleeding vary significantly from cycle to cycle? Do not answer if you have been using hormonal birth control for over 6 months.

Don't know / used birth control for over 6 months
No, my cycles are usually quite similar/regular
Yes, I have occasional moderate cycle variations
Yes, regular moderate variation / occasional major
Yes, regular major variations, very unpredictable

What is the average length of your natural menstrual cycle? Select 'normal' if you have been using hormonal birth control for over 6 months.

Very short (under 21 days)
Short (21 to 25 days)
Normal, 26-31 days / on birth control / don't know
Long (32 to 36 days)
Very long (over 36 days)

Do you have bleeding between periods?

Don't know
No
Occasionally / moderately
Often / severely

How would you rate your average menstrual bleeding?

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

Do you have mood swings related to your menstrual cycle?

No / don't know
Occasionally / moderate
Often / severe

Do you suffer from painful menstrual cramps (painful menstruation)?

Never had them / don't know
Probably had them/minor episode(s) now resolved
Major episode(s) now resolved
Current minor/occasional problem
Current major/regular problem

Do you have poor concentration during certain parts of your menstrual cycle?

No / don't know
Occasionally / moderate
Often / severe

Do you have weight gain greater than 3 pounds (1.5kg) and / or abdominal bloating associated with your cycle?

Do you have a sugar, chocolate or carbohydrate craving associated with your cycle?

No / don't know
Occasionally / moderate
Often / severe

Female Questionnaire
Page 4(i) of 9

This section deals with your periods.

Q499

Q500

Q501

Q502

Q503

Q504

Q505

Q506

Q507

Q508

Q509

Q510

Q511

Q512

Q513

Q514

Q515

Female QuestionnairePage 4(i) of 9