Exit Our Menopause Survey Part 1 We are gathering insights on menopause and want to find out more about your symptoms and solutions. All the questions (besides the first) are optional, and it should only take a few minutes to complete. Thank you! Question Title * 1. Are you or have you experienced symptoms of menopause? Yes No Question Title * 2. Menopausal symptoms I have experienced include: (tick all that apply): Physiological Symptoms: palpitations (heart racing), sweats, flushing, night sweats, unable to sleep, headaches, joint pains, tiredness or stomach bloating, weight gain Psychological and emotional symptoms: changes in mood, irritability, confidence, or anxiousness Symptoms around sex: pain, dryness, low libido, other Vulva/vaginal symptoms: irritation, dryness or soreness, other Question Title * 3. These symptom are affecting (or have affected) my: Never Rarely Sometimes Often Very frequently Ability to work Ability to work Never Ability to work Rarely Ability to work Sometimes Ability to work Often Ability to work Very frequently Relationships Relationships Never Relationships Rarely Relationships Sometimes Relationships Often Relationships Very frequently Enjoyment of life Enjoyment of life Never Enjoyment of life Rarely Enjoyment of life Sometimes Enjoyment of life Often Enjoyment of life Very frequently Next
