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Menopause Questionnaire *

Do you think you're in menopause?

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Disagree

Neutral

Agree

Strongly Agree

Are you experiencing hot flushes or night sweats?

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Disagree

Neutral

Agree

Strongly Agree

Is your memory poorer, or brain foggier?

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Disagree

Neutral

Agree

Strongly Agree

Is it hard to fall asleep?

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Disagree

Neutral

Agree

Strongly Agree

Are you irritable, angery or anxious?

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Disagree

Neutral

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Strongly Agree