Statistics
SURVEY
Cycle Symptoms
Translated
Dr. Notes
Support
Advocacy
About
Contact
Statistics
SURVEY
Cycle Symptoms
Translated
Dr. Notes
Support
Advocacy
About
Contact
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YOUR CART
SURVEY IS NOW OVER.
THANK YOU TO ALL WHO PARTICIPATED.
Survey Questions
For those who have endometriosis or suspect they do.
Thank you for helping bring awareness to endometriosis.
*
Indicates required field
Name
*
First
Last
State / Country
*
First
Last
Email
*
What is your age?
*
Less than 25
25-45
45-65
Over 65
Have you been diagnosed with endometriosis?
*
Yes
No
If diagnosed, which areas of the body has endometriosis been found?
Please select:
*
Reproductive
Urinary
Digestive
Respiratory
Nervous
Circulatory
Endocrine
Skeletal
Integumentary
What
cycle
symptoms do you experience? We each have our unique symptoms, tell us about yours.
Pelvic / Reproductive
*
Cycle Pain
Ovulation Pain
Irregular Cycles
Irregular Bleeding
Blood Clots
Painful Sex
Infertility
Thoracic: Diaphragm / Lung
*
Chest Pain
Shortness of Breath
Rapid Heartbeat
Shoulder Pain
Upper Abdominal Pain
Pain Lying down
Dizziness
Pneumothorax
Pleural Effusion
Coughing Up Blood
Overall
*
PMS
Breast Pain
Migraines
Brain Fog
Mood Swings
Anxiety
Fatigue
Insomnia
Night Sweats
Feeling Cold
Digestive
*
Pain with Bowel
Diarrhea / Constipation
Nausea / Vomiting
Urinary
*
Frequent Urgency
Urinary Pain
Sciatic
*
Lower Back Pain
Pain Down Legs / Knees
Immune System
*
Seasonal Allergies
Food Intolerance
Vitamins and Minerals
*
Low Blood Sugar
Low Magnesium
Low Iron
Thank you for for taking the time
to educate society on how many
there are of us and the depth
of endometriosis.
