Help advance women's hormone health research

This optional, anonymous survey takes about 2 minutes. Your responses are aggregated to support research projects, quality improvement, and clinician education. No personal information is collected.

All questions are optional. Share only what you're comfortable with.

Symptom duration

How long have you been experiencing these symptoms?

Healthcare journey

How many healthcare professionals have you discussed these symptoms with?

Prior diagnoses

Have you ever been given any of these diagnoses? Select all that apply.

Other treatments tried

Beyond hormone treatments, have you tried any of these? Select all that apply.

Most bothersome symptom

Choose the one symptom affecting you most right now.

Quality of life impact

Rate each area from 0 (no impact) to 10 (severe impact).

Work productivity—

Relationships—

Intimacy—

Exercise / activity—

Help us improve women's healthcare — these optional questions support ongoing research. (2 minutes)

Race / Ethnicity

Select all that apply.

Primary language

Where are you located?

How did you hear about Her Hormone Map?

Required: I agree that my de-identified, anonymous responses may be used for research purposes to improve women's healthcare. No personally identifiable information will be shared.

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