Table 3.
Baseline questions.
| Baseline questions and answer field | Skip button | ||||
| Your age | Xa | ||||
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_____ years |
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| BMI calculated from height and weight | X | ||||
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Your height: ____ cm |
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Your body weight: ____ kg |
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| What is the highest level of education you have completed so far? | X | ||||
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High school or above |
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Other |
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| How long is your cycle usually (the time from the first day of period until the beginning of the next period)? | —b | ||||
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_____ days |
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| How long is your period usually? | — | ||||
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_____ days |
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| What kind of period pain and discomfort do you usually experience? (multi-choice possible) | X | ||||
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Stomach cramps |
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General pain in lower belly |
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Lower back pain |
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Headache |
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Nausea/Vomiting |
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Other symptoms, namely _____ |
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| Do you use hormonal contraceptives (eg, birth control pills, hormone patch, vaginal ring, or hormonal IUDc)? | X | ||||
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No |
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Yes |
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If yes, why do you use hormonal contraceptives? |
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I use hormonal contraceptives because of my period pain. |
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I use hormonal contraceptives for contraception. |
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I use hormonal contraceptives because of other reasons (for example, acne). |
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If yes, which hormonal contraceptives are you using? ______ |
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If yes, how long have you been using hormonal contraceptives? for ____ months and ____ years |
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| Have you ever been pregnant? | X | ||||
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No |
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Yes |
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If yes, number of pregnancies:____ |
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If yes, number of births:____ |
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| How intense was the average period pain of the painful days during your last period? | — | ||||
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0 1 2 3 4 5 6 7 8 9 10 (0=no pain at all, 10=most intense pain imaginable) |
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| During your last period, how intense was the worst period pain you experienced? | — | ||||
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0 1 2 3 4 5 6 7 8 9 10 (0=no pain at all, 10=most intense pain imaginable) |
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| On how many days have you had period pain during your last period? | X | ||||
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_____ days |
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| On how many days were you absent from work or education due to period pain during your last period? | X | ||||
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_____ days |
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| Have you taken any medication for your period pain? |
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No | X | |||
| Yes ->if yes, which one: ______ |
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| Which self-care activities have you done during the previous month because of your period pain? (multi-choice possible) | X | ||||
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No actions |
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Fitness/Gymnastics |
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Jogging/Running |
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Acupressure |
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Yoga |
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Autogenic training |
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Herbal medicine |
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Meditation/Relaxation |
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Homeopathy |
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Local supply of heat |
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Food supplements |
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Tea |
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Others: ______ |
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| Which self-care activities have you done during the previous month because of other reasons than your period pain? (multi-choice possible) | X | ||||
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No actions |
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Fitness/gymnastics |
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Jogging/running |
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Acupressure |
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Yoga |
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Autogenic training |
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Herbal medicine |
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Meditation/relaxation |
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Homeopathy |
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Local supply of heat |
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Food supplements |
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Tea |
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Others: ______ |
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| When did you have your last period? Please enter the data of the first day of your last period. | — | ||||
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__.__.____ |
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aX: skip button enabled.
b—: skip button disabled.
cIUD: intrauterine device.