$65 Women's Health Study

Send an email to Philadelphia@usafocusgroups.com and answer these following questions:

1. Name:

2. Age:

3. Which of these categories best describes you?
a. (Pre-menopausal) Still having a regular monthly menstrual period without any signs or symptoms associated with menopause
b. (Peri-menopausal) Still menstruating, but with some period irregularity and/or with some signs or symptoms associated with menopause
c. (Menopausal/Post-menopausal) Have not had a spontaneous menstrual period for at least one year
d. Have had a hysterectomy

4. If yes to menopause, what symptoms have you experienced or are you experiencing that may be associated with menopause?
a. hot flashes/flushes
b. night sweats
c. irritability/moodiness
d. vaginal dryness/irritation
e. vagianl itchiness, burning or soreness
f. painful intercourse
g. none of the above

5. At any point in the past 5 years, have you used any type of estrogen that must be prescribed by a physician?______________________

6. What type of estrogen did your physician prescribe for you?
a. Pill
b. Vaginal cream
c. Vaginal Tablet
d. Vaginal ring

7. Phone Number:

8. Ethnicity:

You will get a phone call from them within 24 hours if you qualify.

Thanks to iMommies for this sharing this info.

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