Menopause Quiz - Mache Seibel, M.D.

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I. Hot Flashes

Please rate the statements below on a scale of zero to ten, with zero indicating “This isn’t what I’m experiencing at all (or anymore),” to ten being “This describes my experience right now completely.”

I am frequently bothered by a sudden "flash" of heat in my body, often accompanied by heavy sweating

I frequently wake up during the night due to night sweats

My hot flashes significantly affect my life or my work

II. Weight Control

Please rate the statements below on a scale of zero to ten, with zero indicating “This isn’t what I’m experiencing at all (or anymore),” to ten being “This describes my experience right now completely.”

I am getting a "spare tire" around my middle despite my efforts to control my weight

I can't seem to lose weight despite eating well and moderate exercise

My clothes keep getting tighter and I haven't changed my eating patterns or exercise habits

III. Mood and Memory

Please rate the statements below on a scale of zero to ten, with zero indicating “This isn’t what I’m experiencing at all (or anymore),” to ten being “This describes my experience right now completely.”

I often feel like I'm walking through life in a fog

I often feel panicked and stressed out

These days everything seems to make me upset, sad or angry

IV. Sleep

Please rate the statements below on a scale of zero to ten, with zero indicating “This isn’t what I’m experiencing at all (or anymore),” to ten being “This describes my experience right now completely.”

I feel like I'm living in a constant state of just plain "worn out" due to lack of sleep

I never get at least 6 hours a night of restful sleep

I wake up at least 3 times during the night

V. Sex, Intimacy, and Vaginal Dryness

Please rate the statements below on a scale of zero to ten, with zero indicating “This isn’t what I’m experiencing at all (or anymore),” to ten being “This describes my experience right now completely.”

My sex drive is non-existent

Even if I wanted to have sex, it hurts so much I'm not as interested or enjoy it less

I frequently suffer from vaginal dryness that impacts my ability to be intimate or comfortable

VI. Bladder Control

Please rate the statements below on a scale of zero to ten, with zero indicating “This isn’t what I’m experiencing at all (or anymore),” to ten being “This describes my experience right now completely.”

I often feel the sudden urge to urinate, and it has become a big problem for me

I'm terrified to cough or sneeze for fear I'll wet my pants

I am constantly worried that I won't be able to "hold it" and will have an embarrassing accident

Ready to Handle It?

0 = Not Committed 10 = Highly Committed

I can't wait another week to find some solutions to what I'm experiencing

I'm ready to invest in myself to change my menopause experience

I know I can't figure this out by myself and I need support

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Please choose the option that best describes you:(Required)

I am still experiencing periods, at least irregularly

I haven't had a period for at least 12 consecutive months

I haven't had a period for at least 24 consecutive months

The information submitted will only be used by Mache Seibel for the purpose of sending you your results.

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