|
Section 1. Menstrual-cycle-related signs and symptoms (rating scale) |
|
1.1 The problem of blood in the uterus |
1. You have thick texture menstrual blood. |
2. Your menstrual blood looks like egg whites. |
3. Your menstrual blood smells stronger than usual or smells like rotten meat. |
4. You have a lot of menstrual blood clots which are released every day, or large-size clots (greater than or equal to 2 centimeters). |
5. You have a lot of vaginal discharge that you need to put on a sanitary pad and your vaginal discharge is eggy, clear, stretchy, or thick white. |
6. Your vaginal discharge is an abnormal color with a bad smell (abnormal color: yellow, green, brown or blood). |
7. Before the menstrual period, you have vaginal discharge and vaginal itching. |
|
1.2 Irregular menstrual blood |
8. You have light or heavy menstrual bleeding throughout the cycle (using less than 2 pads per day or more than 4 pads per day). |
9. Your menstrual blood color is pale red, bright red, orange, dark red, dark brown, or black. |
10. In one period, you have many colors of menstrual blood. |
|
1.3. The musculoskeletal system |
11. Hot and cold flushes or fever |
12. Muscle pain/lower back pain |
13. Joint pain/bone pain |
14. Fatigue |
15. Breast pain/tender breasts |
16. Abdominal cramps |
|
1.4. The digestive system (intestine and mesentery) |
17. Loose/watery stools five or six times a day |
18. Colic in the abdomen or flanks |
19. Abdominal bloating/abdominal discomfort |
|
1.5 The heart (mind aspect) |
20. Waking up with a fright/insomnia |
21. Irritability and/or anger |
22. Depression and/or crying |
23. Anxiety and/or tension |
|
Section 2. Associated factors (rating scale) |
2.1. Emotion and feeling |
24. You feel anxious or worried. |
25. You are irritable or angry. |
26. You are bored, depressed, or in despair. |
|
Section 2. Associated factors (rating scale) |
2.2. Types of drink |
27. You like to drink ice-beverages or frappe. |
28. You like to drink caffeine beverages (e.g., chocolate, tea, carbonated beverage, energy drinks, coffee). |
|
2.3. Types of food |
29. You like to eat strong-flavored foods, e.g., extremely spicy, extremely sour. |
30. You eat preserved food and/or uncooked food, e.g., fruit preserves, sashimi, and medium to raw meat. |
|
2.4. Environment |
31. You work or stay in a bad environment for a long time a day (in the area too hot or cold/exposed to or inhaling chemicals). |
32. In one day, you must enter and exit the area with temperature differences (hot and cold). |
|
2.5. Behaviors and health problems |
33. You work hard (using a lot of energy or muscle power). |
34. You have sleep problems, e.g., insomnia, waking up with a fright in the middle of the night. |
35. You have constipation. |
|
Section 2. Associated factors (multiple choice) |
2.6. Personal data |
36. How old are you? |
37. Date and time of birth |
38. Weight and height |
|
2.7. Medical history |
39. What is your health problem or underlying disease? |
40. Have you ever had an accident that injured your lower back or lower abdomen? |
41. Have you ever had abdominal surgery? |
|
2.8. Ob-gynecologic history |
42. How old were you when your first period start? |
43. Have you ever given birth to a child? |
44. What postpartum care did you have? |
45. Have you ever miscarried? |
46. Have you ever had a curettage? |
47. Have you ever used hormonal birth control? |
48. Has your grandmother or mother had a menstrual disorder history? |
49. When did your menstrual symptoms first occur? |
|