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 told you had any of the following? Select all that apply.

Previous treatments

Which treatments have you already tried? Select all that apply.

Most bothersome symptom

Choose the one symptom affecting you most right now.

Menopause history

Select all that apply.

History of hysterectomy

Care preference

If available, how would you prefer to receive menopause care?

Quality of life impact

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

Work productivity—

Relationships—

Intimacy—

Exercise / activity—

Patient experience

Have you ever felt your symptoms were dismissed by a healthcare professional?

Help us improve women's healthcare — these optional demographic questions support ongoing research.

Race / Ethnicity

Select all that apply.

Primary language

Insurance status

ZIP code

Optional — 5 digits. Helps us study geographic access to care.

Highest education completed

Employment status

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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