Health Questionnaire - Female

Click the Tick Box to accept the condition that applies to you. This survey covers four major areas:

PMS
Ovarian Dysfunction
Dysplasia/Fibrocystic Syndrome
Menopause
Bone Integrity
Menstrual Irregularities

At the completion of the survey count the number of responses you have ticked and click here to see the Interpretation.

PMS		Ovarian Dysfunction
Are you concerned about....?		Are you concerned about....?
Insomnia		Vaginal dryness, pain
Abdominal bloating		Painful intercourse
Breast tenderness, swelling		Engorged breasts
breast lumps appear		Milk production (not nursing)
Heart palpitations		Disinterest in sex
Sweating and flushing		Blurred vision
Depressed, irritable, nervous		Headache
Easily angered, fearful		Acne and/or oily skin
Easily overwhelmed		Aggressive feelings
Nausea and/or vomiting		Overwhelming urges for sexual intercourse
Diarrhea or constipation		Absence of menstrual flow for six months or more
Headache		Occasionally skip periods
Food cravings, binge eating		Menstruation began after 16 years of age
Back pain		Breasts shrinking
Numbness, tingling in the hands and feet		Thinning pubic and armpit hair
Clumsiness		Unable to become pregnant
Feeling hopeless, sad		Miscarriage
Suicidal		Excess facial hair
Weight gain - water		Poor sense of smell
Total the number of ticks and put in the box		Monthly abdominal pain without bleeding
	Goto Top	Total the number of ticks and put in the box
			Goto Top
Dysplasia/Fibrocystic Syndrome		Menopause
Are you concerned about....?		Are you concerned about....?
Painful, tender vaginal lumps		Irregular menstrual cycle
Clear, grey or yellow vaginal discharge		Dry hair, skin, vagina
Vaginal bleeding after intercourse or between periods		Disinterest in sex
Burning or itching of the external genitalia		Mood swings, irritable
Urgent, painful urination		Depression, anxiety, nervousness
Lower abdominal or back pain		Craving for sweets, binge eating
Heavy, watery or bloody vaginal discharge		Headaches or dizziness
Heavy menstrual flow		Painful intercourse
Pelvic cramps		Sudden hot flushes
Thin, scant,white vaginal discharge		Spontaneous sweating
Greenish, yellow or offensive discharge		Shortness of breath and/or heart palpitations
White. cheeselike discharge		Unpredictable vaginal bleeding
Breast lumps or swelling		Difficulty holding urine
Lumps hurt just before period		Difficulty sleeping
Swelling under armpit		Mental fogginess
Change in breast size, shape		Vaginal pain and/or itching
White or slightly bloody vaginal discharge one week before period		Thin, scant, white vaginal discharge
Total the number of ticks and put in the box		Lower back and/or hip pain
	Goto Top	Breast tenderness, pain or tingling, pricking sensation
		Easily bruised, loss of skin tone
Bone Integrity		Thinning of armpit or pubic hair
Are you concerned about....?		Breasts beginning to shrink, sag
Generalised bone tenderness,achiness		Abnormal growth of hair above lip
Localised bone pain		Total the number of ticks and put in the box
Bone deformity or swelling shins hurt during or after exercise			Goto Top
Lower back or hip pain
Difficulty sitting straight		Menstrual Irregularities
Walking difficulties, limp		Are you concerned about....?
Crunchiness or creaking sounds when moving joints		Vaginal dryness, pain
Hands, feet, throat spasm or feel numb		Painful intercourse
Joint pain or stiffness, especially spine, hips, knees		Engorged breasts
Hearing loss, headache,ringing in ears		Milk production (not nursing)
Cavities		Disinterest in sex
Tooth loss due to gum disease		Blurred vision
Established bone loss		Headache
Calcium deposits		Acne and/or oily skin
Spinal curvature		Aggressive feelings
Recent loss of height		Overwhelming urges for sexual intercourse
Bow legs		Absence of menstrual flow for six months or more
Stooped posture		Occasionally skip periods
Hump at base of neck		Menstruation began after 16 years of age
Irregular patches of increased pigmentation		Breasts shrinking
Unexplained bone fracture		Thinning pubic and armpit hair
Total the number of ticks and put in the box		Unable to become pregnant
	Goto Top	Miscarriage
		Excess facial hair
		Poor sense of smell
		Monthly abdominal pain without bleeding
		Total the number of ticks and put in the box
			Goto Top

Interpretation.

It is not possible to allocate scores and relate them to your health. If the number of ticks in your survey appears too high you have a deep desire to improve your health. Why not Contact us at the Hervey Bay Wellbeing Centre with your concerns.