Table 1.

Sample of Survey Questions

		Have you ever had the following problem?	Are you currently (in the last 6 months) experiencing the problem?	How long did you have the problem?	Did you seek care from a doctor or healthcare provider for the problem?
9.	Irregular or unpredictable menstrual periods	□ Yes	□ Yes	□ Never	□ Yes
		□ No (If “No,” skip to the next row)	□ No	□ Less than 6 months	□ No
				□ 6–12 months	□ Never had irregular periods
				□ More than 1 year
				□ Always
10.	Bleeding in between menstrual periods	□ Yes	□ Yes	□ Never	□ Yes
		□ No (If “No,” skip to the next row)	□ No	□ Less than 6 months	□ No
				□ 6–12 months	□ Never had bleeding in between periods
				□ More than 1 year
				□ Always
11.	Heavy menstrual periods	□ Yes	□ Yes	□ Never	□ Yes
		□ No (If “No,” skip to the next row)	□ No	□ Less than 6 months	□ No
				□ 6–12 months	□ Never had heavy periods
				□ More than 1 year
				□ Always