Manage My Menopause
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Menopause Advice

You are here: Home / Menopause Advice

Step 1 of 6 - Contact Information

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  • Thank you for completing the ‘Manage my Menopause’ questionnaire. The questionnaire contains a number of different sections and will take about 15 minutes to complete. We will use this data to tailor our advice to you specifically. As such, we request that you complete it as thoroughly as possible to ensure that you receive the correct advice.

    Once you have completed the questionnaire you will be able to view your tailored advice. As a not for profit organisation, we ask that you consider making a small donation to help maintain this information resource. if you are happy to make a donation it will allow you to download your advice document as a PDF and refer to it at a later date.

    In addition to providing you with tailored advice about your post-reproductive health we would also like to collect the information you give us in a database. This data will be anonymised and used to collect information about post-reproductive symptoms, health concerns and risk factors. We hope to use this to develop our understanding of the needs of the post-reproductive population and to develop and update this advice portal.

    Data protection statement: your data will be managed in accordance with the Data Protection Act 1998.

  • Optional- if you enter an email address here we'll ask if you want to be kept updated on post-reproductive research and you can also save your progress through the questionnaire if you want to continue later, we'll email you a link to continue the questionnaire when it's convenient for you.
  • We would also like to contact you via email in the future to request feedback about our website, ask you to be involved in further research about post-reproductive health and notify you of updates to the ‘Manage my Menopause’ advice portal. Please indicate the circumstances in which you would be willing to be contacted by us
  • Please could you indicate how you would like us to manage the data you have provided (please tick one box)
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  • Please select your country
  • Enter your height. If you are 5ft 3in, put '5' in the feet box and '3' in the inches box
  • Enter your weight
  • Enter your height in meters. If you are 1.5m tall, enter '1.5' in the meters box
  • Enter your height in centimetres. If you are 1.5m tall, enter '150' in the centimetres box
  • Enter your weight
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  • Step 2 - Details about your menopause

  • Choose one option that best describes your menopausal status
  • Do you know the date of last menstrual period (LMP)
  • Date Format: DD slash MM slash YYYY
  • Please choose one option for frequency, duration and heaviness of bleeding
  • Please select all that apply
  • Please tell us about your menopausal symptoms

    Check all that apply

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  • Details about your lifestyle

    Please be as honest as possible with you answers to allow us to give you accurate advice on your post-reproductive health

  • How much exercise do you do in an average week?

    We need to know how much time you spend exercising and also how intense that exercise is.

  • Moderate exercise increases your heart rate & breathing and makes you feel warm but during it you’ll still be able to talk normally. e.g. walking fast or riding a bike
  • Vigorous exercise increases your heart rate quite a bit and means you are breathing hard so talking in sentences is difficult. e.g. jogging, swimming, playing tennis
  • We need to know how healthy your diet is and what sort of foods you eat. Please tick all that apply
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  • Family History

    Please share with us whether any of your close relatives have been diagnosed with cancer as this may influence your risk of disease. Please consider only first degree relatives such as your parents, your siblings and your children

  • If you don't know their age, please leave blank
  • If you don't know their age, please leave blank
  • If you don't know their age, please leave blank
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  • Your medical history

    Please tell us about your medical history as this influences you future health and allows us to advise you on whether these medications could influence other treatments you may wish to use

  • Tick all that apply
  • We would like to find out your risk of blood clots such as a deep vein thrombosis (DVT) or a pulmonary embolism (PE), so that we advise you about the risk of these conditions in the future and how safe medication such as hormone replacement therapy may be for you
  • If unknown leave blank
  • Please tick all that apply
  • Please tick all that apply
  • Do you know your most recent blood pressure reading? When blood pressure is taken you get two numbers systolic pressure/diastolic pressure, often said as one number over another number e.g. 120 over 80.
  • If you know them, please enter your Cholesterol readings here
  • Blood cholesterol is measured in units called millimoles per litre of blood, often shortened to mmol/L
  • High-density lipoprotein (HDL) measured in units called millimoles per litre of blood, often shortened to mmol/L
  • Your ratio of total cholesterol to HDL
  • Have any of your first degree relatives (your parents, siblings or children) been diagnosed with cardiovascular disease at less than 60 years of age?
  • The QRISK®2 score is your risk of having a heart attack or stroke over the next ten years. To calculate your QRISK®2 you need to visit an external website. The link is below. Please complete the QRISK®2 questions and enter your score
  • If you'd rather not say, please leave this field blank, please enter a number only
  • Please tick all that apply.
  • Please provide your ten year probability of major osteoporotic fracture, if you know it. If you'd rather not say, please leave this field blank, please enter a number only
  • If you'd rather not say, please leave this field blank, please enter a number only
  • This field is for validation purposes and should be left unchanged.
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Help

Please use the "Previous" & "Next" buttons at the bottom of each page to navigate throughout the questions, rather then using your browsers back button.

If you want to save your progress and come back to the form later, please make sure you enter an email address and click "Save and Continue Later" link at the bottom of the page.

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