MEN - GO TO QUESTION 17, PAGE 7

The following questions 13-16 are being asked of WOMEN ONLY:

13a.	Have you had a menstrual period in the last 12 months? (Circle your answer.)

1 Yes	2 No	13b.	What age were you when you had your last period?

Age________

13c.	Have you gone (or are you currently going) through menopause? (Circle your answer.)

1 Yes	13d.	Was menopause induced or hastened by a hysterectomy (surgical removal of your uterus and/or ovaries)? (Circle your answer.)

2 No

1 Yes	2 No

14a.	Have you ever taken hormones or birth control pills for menopausal or aging symptoms? (Circle your answer.)

1 Yes	14b.	At what age did you first start taking them for these symptoms?

2 No	Age___________

14c.	Are you currently taking them? (Circle your answer.)

1 Yes	2 No

15a.	To what extent do or did you experience the following menopausal symptoms? Circle one number for each symptom. Not at all A little Somewhat A lot a.	hot flushes/flashes 0 1 2 3 b.	depression 0 1 2 3 c.	sleep disturbance 0 1 2 3 d.	bone pains 0 1 2 3 e.	night sweats 0 1 2 3 15b.	To what extent are you currently experiencing any menopausal symptoms?

0

1

2

3

16.	Please respond to the following set of questions which relate to feelings you may have had (or continue to have) about menopause. (Circle one number for each row.) Going through menopause has affected or is likely to affect my: In a positive way Both positive and negative In a negative way No effect a.	Family life 1 2 3 4 b.	Work life 1 2 3 4 c.	Feelings about myself as a woman 1 2 3 4