Get your free Well Woman Project workbook

What is your full name?*

I would like to learn a bit more about your cycle…

1a. What is the average length of your cycle (your whole cycle, not just your period), and is it the same every month?

1b. How long does your period last?

2. During your period how often do you need to change your sanitary protection? What do you use?

3. Do you pass clots during your bleed that are the size of 10p or larger?
YesNo

4. Do you ever feel nauseous and sick during your cycle or period?
YesNo

5. Do you experience a heavy dragging feeling in your uterus/pain in your legs/lower back during your period?
YesNo

6. Do you always have to take pain medication during period? What do you take?

7. Do you find when you go for a smear test they have difficulty locating your cervix or they ask you to sit on your hands?

8. Do you experience pain during sex?
YesNo

9. Do you get bloated for no apparent reason?
YesNo

10. Do you need to take time off school/work/social engagements because of your period?
YesNo

11. Have you had any problems trying to conceive? Have you had any problems trying to conceive?
YesNo

12. How long have you had these symptoms?

Finally… how did you hear about the Well Woman Project?

Thank you for your answers. Hopefully I can help you.

Which email should I sent your workbook to?*

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