Menopause Questionnaire

Take our Questionnaire (below) and come in for a FREE 15 minute check in – to help us find the best product for you!

We are all unique and as such our experience of the menopause will also be! The average age for the menopause is between 45 and 55 yrs old. There are many symptoms which can occur, but the number and severity of these will vary from woman to woman.

There are however, a number of key factors which will determine whether we have a rough ride or a smooth one! Some of these factors which disrupt our hormones include: refined or processed foods, sugar, caffeine, alcohol, stress, not enough water, poor quality sleep and too much stress. In addition the gut and liver need to be functioning well, so if our gut bacteria are out of balance or the liver is over burdened, for example, these will also have an impact on Menopausal symptoms. The earlier these factors are addressed the better, so if you haven’t yet reached the menopause, start making changes now! It will be worth it!

Here are some common symptoms of the Menopause:

• Hot flushes
• Night sweats
• Mood swings
• Irritability
• Low mood or depression
• Anxiety
• Poor memory
• Fatigue
• Painful joints / aching muscles
• Frequent trips to the loo / cystitis
• Weight gain around the middle
• Tender breasts (please check with your GP if you have any changes in breast health)
• Sleep disturbances

Although there are plenty of supplements to support the menopause, sometimes we need to look at other areas of our health and support those as well, in order to see a difference in symptoms.

We would love to help you, so we’ve put together a questionnaire (below), which helps identify the areas that need supporting. Fill it in and bring it along to a FREE 15 minute check in (please book), with one of our Registered Nutritional Therapists, who can then suggest the most suitable supplements for you, as well as giving any dietary advice.

If you’re already taking supplements for the Menopause, why not book in for a FREE 15 minute check in anyway and get those supplements reviewed, to see if anything needs changing?

A final and most important word: RELAXATION !!

This a phase in your life when you need to take time out to look after yourself, not just for easing any menopause symptoms but to prepare the way for healthy years ahead, beyond the menopause. So make time for you every day and each week do things you really enjoy.

This is a naturally a time to reflect and make changes to your health and life for the better!

QUESTIONNAIRE FOR MENOPAUSE:

1. Are you still having periods?                                                                                         YES / NO

If Yes – are there any changes? (eg lighter/heavier/missing some)                            YES / NO
If No – how long ago did they stop?……………………………………………………………….

2. Are you having any symptoms?                                                                                    YES / NO
If Yes, please circle which ones:

• Hot flushes / night sweats
• Mood swings /irritability / low mood or depression
• Anxiety
• Poor memory
• Fatigue
• Painful joints / aching muscles
• Frequent trips to the loo / cystitis
• Weight gain around the middle
• Tender breasts (please check with your GP if you have any changes in breast health)
• Sleep disturbances

3. Are you on any medication?                                                                                         YES / NO
(Eg HRT, the contraceptive pill or coil, or any other medication at all?)

If yes, please state which here…………………………………………………………………………………………….

4. Are you taking any supplements regularly?                                                              YES / NO
If Yes, please specify…………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………….

5. Are you under any stress?                No / A little / A moderate amount / A lot / Severe!
If Yes, how long has it been for?……………………………………………………………..

6. Are you getting enough sleep? (7/8hrs +)                                                                    YES /NO
If No, how many hours do you get per night?……………………………………………….

What time do you go to bed?……………………………………………………………………..

Do you have disrupted sleep ?      waking in night / difficulty getting to sleep         YES /NO

7. Do you eat 3 meals a day at regular times? (with or without snacks)                    YES / NO

8. Do you have protein with each meal?                                                                       YES / NO
(circle the ones you have : nuts/ seeds/fish/chicken/meat/tofu/cheese/lentils/beans)

9. Are you: Vegan / Vegetarian / Other (please circle)  …………………………………..     YES / NO

10. Do you eat oily fish?                                                                                                        YES / NO
If Yes, how often?……………………………………………………………………………………

11. Do you drink 1.5/ 2 litres water a day (or herbal teas)?                                           YES / NO

12. Do you drink regular tea or coffee or decaffeinated tea (circle which)                 YES / NO
If Yes, how much……………………………………………………………………………………..

13. Do you drink alcohol?                                                                                                      YES / NO
If yes, how many units per week?……………………………………………………………..

14. Do you crave sweet things?                                                                                             YES / NO

15. Do you exercise regularly?                                                                                               YES / NO
If yes, please specify. Activity:………………………………………How often?………………………..….

16. Do you have time to relax or have ‘me time’? (please circle)
Never or hardly / 1 or 2 x a week / a few times a week / most days or evenings

 

Please bring the questionnaire in with you (or find a copy in the shop), to allow us to help you!