Peri/Menopausal Women's Health Survey - Anonymous from the Institute of Women's Futures) Question Title * 1. What is your age? 35-45 46-55 56-65 66-75 76-80 80+ Question Title * 2. What is your ethnicity and/or racial background? American Indian or Alaska Native Asian or Asian American South Asian Black or African American Hispanic or Latino Middle Eastern or North African Native Hawaiian or other Pacific Islander White Another race Prefer not to answer Question Title * 3. What is your annual household income? Under $15,000 Between $15,000 and $29,999 Between $30,000 and $49,999 Between $50,000 and $74,999 Between $75,000 and $99,999 Between $100,000 and $150,000 Over $150,000 Over $250,000 Question Title * 4. What level of insurance do you currently hold? Standard coverage from my employer Excellent coverage from my employer Standard coverage through a spouse or family member Excellent coverage through a spouse or family member Medicaid/Medicare/ Tricare (or any government insurance) No coverage Question Title * 5. What are your current perimenopause/menopause symptoms? (Check all that apply) Hot flashes Night sweats Brain fog Mood swings Vaginal dryness Recurring UTIs Low libido/ low sex drive Memory loss Urinary urgency Difficulty sleeping and/or disturbed sleep Migraines Painful breasts Irregular periods Heavy bleeding Weight gain Anxiety Depression Rising cholesterol Other (please specify) Question Title * 6. How severe are your symptoms on a daily basis? Extremely severe Moderately severe Generally manageable Easily manageable Other (please specify) Question Title * 7. Are you fully menopausal (have you gone one year or more without a period)? Yes, I've gone more than 1 year without a period No, I still have semi-regular or regular periods Question Title * 8. If you’re fully menopausal, was it surgical or natural? Surgical, the result of a full or partial hysterectomy Natural, no full or partial hysterectomy Question Title * 9. How important are these qualities in your perimenopausal/menopausal healthcare provider: Urgent Very important Somewhat important Not very important Supportive, kind, good listener, trustworthy Supportive, kind, good listener, trustworthy Urgent Supportive, kind, good listener, trustworthy Very important Supportive, kind, good listener, trustworthy Somewhat important Supportive, kind, good listener, trustworthy Not very important Takes my insurance Takes my insurance Urgent Takes my insurance Very important Takes my insurance Somewhat important Takes my insurance Not very important Provides evidence-based treatment options Provides evidence-based treatment options Urgent Provides evidence-based treatment options Very important Provides evidence-based treatment options Somewhat important Provides evidence-based treatment options Not very important Open to other treatment options that I choose Open to other treatment options that I choose Urgent Open to other treatment options that I choose Very important Open to other treatment options that I choose Somewhat important Open to other treatment options that I choose Not very important Can work within my budget Can work within my budget Urgent Can work within my budget Very important Can work within my budget Somewhat important Can work within my budget Not very important Other (please specify) Question Title * 10. Would you be willing to pay cash for the menopausal care you feel you need? Yes No Other (please specify) Question Title * 11. Are there any other chronic conditions (mental and/or physical) that you deal with on a daily basis? Mental Health/Wellness/Acuity Immunodeficiencies Diabetes Heart Disease Stroke Other (please specify) Question Title * 12. What concerns you most about aging and menopause? Symptoms Persisting (hot flashes, night sweats, insomnia, etc.) Risk of Dementia/Alzheimers Loneliness/Lack of Community Housing/Financial Insecurity Chronic Illness/Decline Other (please specify) Done