FYP: Quiz
Nicole Jardim
2017-09-15T11:49:58-04:00
Important:
When you answer the questions, please tell me what's happening right now with your menstrual cycle. This will allow me to more accurately assess your health concerns.
Once you fill out the form below and submit your answers, y
ou will immediately be taken to the 1st lesson of your customized
Fix Your Period Quickstart Kit.
Plus you will receive an email with your specific results.
*denotes a required field
*1. Which of these best describes your menstrual cycle CURRENTLY?
Select...
A. I get my period every 25-35 days
B. I get my period every 24 days or less (short cycles)
C. I get my period every 36 days or more (long cycles)
D. My period feels like it is irregular and just all over the place
E. I currently don't get my period (I have not had a period for 3 months or more)
*2. If you currently get your period, how many days does your period last (not including spotting before and after your period)?
Select...
A. 2 days or less
B. 3-7 days
C. 8 days or more
D. I currently don't get my period (I have not had a period for 3 months or more)
*3. If you currently get your period, how often do you change pads or tampons?
Select...
A. Once a day or less
B. More often than every 1-2 hours
C. Every 3-4 hours
D. I currently don't have a period
*4. Are you currently using hormonal contraceptives/birth control? (This includes the birth control pill, patch, IUD, implant, & Nuvaring)
Select...
A. Yes, I am currently on hormonal birth control.
D. I was on hormonal birth control but I stopped using it LESS THAN 6 months ago
C. I was on hormonal birth control but I stopped using it MORE THAN 6 months ago
B. No, I have never been on hormonal birth control.
*5. Have you been diagnosed with OR are you currently experiencing any of the following?
Select...
A. PCOS
B. Endometriosis
C. Fibroids
D. Ovarian Cysts
E. PMS or PMDD
F. Amenorrhea (no period)
G. Hashimoto's or Hypothyroid
H. None of the above
To select multiple: Hold Command (Mac) or Control (PC) on your keyboard and select
*6. Do you currently struggle with physical OR emotional PMS symptoms that disrupt your life? (Low mood, anxiety, anger, bloating, weight gain, acne, crazy cravings, breast tenderness/swelling?)
Select...
A. Yes
B. No
*7. Do you experience any of the following at any time during the month?
Select...
A. Moodiness or depression
B. Low sex drive
C. Hair loss
D. Headaches or migraines
E. Energy crashes throughout the day
To select multiple: Hold Command (Mac) or Control (PC) on your keyboard and select
*8. At the beginning and during my period, I experience:
Select...
A. No cramps
B. Mild to medium cramps that don't disrupt my day
C. Ouch! Severe cramps that prevent me from going to school or work
D. I currently don't have a period
*9. Do you feel tired and weak leading up to your period, OR do you generally feel fatigued at other times in the month?
Select...
A. Yes
B. Sometimes
C. No
*10. You aren't able to get rid of excess fat or lose weight no matter what you do.
Select...
A. Yes I have trouble losing weight
B. No, I don't have trouble losing weight
*11. When you wake up in the morning how's your energy level?
Select...
A. I feel somewhat rested
B. I can't get out of bed
C. I get out of bed OK but I feel pretty sluggish throughout the day
*12. You look in the mirror and notice a huge zit....
Select...
A. Yeah, that usually happens when I'm getting my period
B. Very unusual. I normally don't get acne
C. I wish it was just one zit! I'm dealing with acne all of the time
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