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Menstrual Health & Wellness Survey

What age group do you belong to?

*

A

Under 18

B

18-24

C

25-34

D

35-44

E

45 - 55

F

55 and above

What city do you live in?

*

Who do you live with

*

A

By myself

B

With parents / family

C

With spouse / partner

D

With friends or roommates

E

Other

What is your current occupation?

*

A

Student

B

Homemaker

C

Salaried employee

D

Self employed / entrepreneur

E

On a break ( eg. maternity leave)

F

Retired

G

Other

Highest education level completed

*

A

Up to 12th grade ( high school )

B

Undergraduate degree

C

Post graduate degree

D

Other

Which stage best describes your current reproductive health?

*

A

I haven’t started menstruating yet

B

I have a regular menstrual cycle

C

I have irregular periods or a diagnosis like PCOS/PCOD

D

I am pregnant / postpartum

E

I am perimenopausal or menopausal