Female Questionnaire
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This section deals with hormone use.

Q892

Thyroid Hormone Replacement Therapy: Are you currently being treated? If unsure of which type you are using, click the following links for examples: T4 only, T3 only, synthetic T3-T4 combination, desiccated pig glandular.
  • No / don't know
  • Yes, with T4 only
  • Yes, with T3 only
  • Yes, with a synthetic T3-T4 combination
  • Yes, with a desiccated pig glandular

Q893

Have you used cortisol (hydrocortisone)? Only include tablets of cortisol taken orally, not cortisone shots or creams.
  • Don't know
  • No
  • In the past only
  • Current use for less than 6 months
  • Current use for 6 months or longer

Q894

If you are currently using cortisol, what is your total daily dose?
  • Not applicable / don't know
  • Less than 10mg
  • 10 to 20mg
  • 21 to 30mg
  • Over 30mg

Q895

Have you used DHEA?
  • No / don't know
  • For under 1 year, but not any more
  • For 1 or more years, but not any more
  • Current use for under 1 year
  • Current use for 1 or more years

Q896

Are you using Glucophage or Glucophage XR (Metformin - a biguanide agent)? This is a blood sugar and insulin-lowering medication.
  • Don't know
  • No
  • Less than 1000mg per day
  • 1000mg to 1500mg per day
  • Over 1500mg per day

Q897

Have you used melatonin within the past year?
  • Never used it / not within past year / don't know
  • I tried it, but it makes me agitated
  • I tried it, but it does not help
  • Current/recent occasional use
  • Current/recent regular use

Q898

Have you used testosterone?
  • No / don't know
  • For under 1 year, but not any more
  • For 1 or more years, but not any more
  • Current use for under 1 year
  • Current use for 1 or more years

Q899

Are you currently taking birth control pills?
  • Don't know
  • No
  • Yes, for a year or less
  • Yes, for 2-4 years
  • Yes, for more than 4 years

Q900

If not currently using birth control pills, have you used them in the past 5 years?
  • Not applicable / don't know
  • Never used them
  • Yes, I used them for less than a year
  • Yes, I used them for 1-2 years
  • Yes, I used them for over 2 years

Q901

Have you used non-human estrogens (such as Premarin, Estrace, or Prempro)? In the past, it may have been referred to as HRT (Hormone Replacement Therapy).
  • No / don't know
  • For under 5 years, but not any more
  • For 5 or more years, but not any more
  • Current use for under 5 years
  • Current use for 5 or more years

Q902

Have you used natural estrogens? They are usually known as E1 (estrone), E2 (estradiol) and E3 (estriol) or when combined as Bi-est or Tri-est.
  • No / don't know
  • For under 5 years, but not any more
  • For 5 or more years, but not any more
  • Current use for under 5 years
  • Current use for 5 or more years

Q903

Have you used progestins (such as Provera or Depo-Provera/DMPA)? Prempro contains a progestin also.
  • No / don't know
  • For under 1 year, but not any more
  • For 1 or more years, but not any more
  • Current use for under 1 year
  • Current use for 1 or more years

Q904

Have you used natural progesterone? This does not include wild yam products which normally have no progesterone in them.
  • Don't know
  • No
  • In the past, but not currently
  • Current use for under 1 year*
  • Current use for over 1 year*
* more questions will be asked later
Report by The Analyst™
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  • consent to collect data
  • name, age, and gender

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