Mock: Mata Parkinson's Disease Women's Health Questionnaire //
This questionnaire will discuss menstruation, child-bearing, hormonal disorders/cancer, menopause, and your PD experiences. Dictionary: Perimenopause - "around menopause" and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years. This is highlighted by a period of irregular menstruation.Menses - the menstruation cycle. Pre-eclampsia - a pregnancy complication characterized by high blood pressure. Dyskinesia - abnormality or impairment of voluntary movement. Dystonia - a state of abnormal muscle tone resulting in muscular spasm and abnormal posture, typically due to neurological disease or a side effect of drug therapy.Premenstrual syndrome (PMS ) - a condition that affects a woman's emotions, physical health, and behavior during certain days of the menstrual cycle, generally just before her menses. Symptoms include: mood swings, tender breasts, food cravings, fatigue, irritability, and depression.
**Some questions may be hidden and will only appear based on your answers. Do not be concerned if there are numbered questions that appear missing.** 1. What is your current age?
in years
What year were you diagnosed with PD?
(ex/ 2021)
What year did you first notice PD symptoms (usually is the same year or before PD diagnosis)?
(ex/ 2020)
2. My Parkinson's onset started...
While I was still having regular periods
While I was going through perimenopause
One year or more after my last menstrual period
While I was still having regular periods
While I was going through perimenopause
One year or more after my last menstrual period
3. Are you still menstruating?
Yes
No
At what age did you start menstruating?
4. Have you ever been diagnosed with Premenstrual Syndrome (PMS)?
Yes
No
5. Are you perimenopausal?
Yes
No
Has a doctor checked to see if your hormone levels have changed for perimenopause?
Yes
No
6. Have you experienced menopause?
Yes
No
Duration of menstruation (in years):
7. Did/Do you notice that PD symptoms improved at any part of the menstrual cycle?
Yes
No
When did/do you notice that PD symptoms improved?
8. Is there anything else you've noticed about your period/cycles and your PD symptoms?
9c. What did you notice with symptoms worsening around menses (check all that apply)?
During this period of worsening slowness of movement, does additional dopamine relieve symptoms?
During this period of worsening rigidity, does additional dopamine relieve symptoms?
During this period of worsening tremor, does additional dopamine relieve symptoms?
During this period of worsening NMS, does additional dopamine relieve symptoms?
During this period of worsening dystonia, does additional dopamine relieve symptoms?
During this period of worsening dyskinesia, does additional dopamine relieve symptoms?
During this period of worsening swallowing issues, does additional dopamine relieve symptoms?
During this period of worsening speech impairment, does additional dopamine relieve symptoms?
During this period of worsening constipation, does additional dopamine relieve symptoms?
During this period of worsening other digestive issues, does additional dopamine relieve symptoms?
During this period of worsening urinary control impairments, does additional dopamine relieve symptoms?
During this period of worsening depression, does additional dopamine relieve symptoms?
During this period of worsening anxiety, does additional dopamine relieve symptoms?
During this period of worsening trouble falling asleep, does additional dopamine relieve symptoms?
During this period of worsening trouble staying awake, does additional dopamine relieve symptoms?
During this period of worsening pain, does additional dopamine relieve symptoms?
During this period of worsening concentration issues, does additional dopamine relieve symptoms?
During this period of worsening restless legs, does additional dopamine relieve symptoms?
10. How old were you when your periods/menses stopped?
11. Did you have any of these symptoms during perimenopause?
Did your slowness of movement improve with dopamine?
Yes
No
Did your rigidity (stiff muscles) improve with dopamine?
Yes
No
Did your (action/resting) tremor improve with dopamine?
Yes
No
Did your dystonia improve with dopamine?
Yes
No
Did your dyskinesia improve with dopamine?
Yes
No
Did your swallowing issues improve with dopamine?
Yes
No
Did your speech impairment improve with dopamine?
Yes
No
Did your neuroleptic malignant syndrome (NMS) improve with dopamine?
Yes
No
Did your constipation improve with dopamine?
Yes
No
Did your other digestive issues improve with dopamine?
Yes
No
Did your urinary control impairments improve with dopamine?
Yes
No
Did your depression improve with dopamine?
Yes
No
Did your anxiety improve with dopamine?
Yes
No
Did your trouble falling asleep improve with dopamine?
Yes
No
Did your trouble staying awake improve with dopamine?
Yes
No
Did your pain improve with dopamine?
Yes
No
Did your concentration issues improve with dopamine?
Yes
No
Did your restless legs at night improve with dopamine?
Yes
No
13. Check all the surgeries you have had AFTER developing PD.
At what age did you have this surgery(s)?
At what age did you have this surgery(s)?
At what age did you have this surgery(s)?
At what age did you have this surgery(s)?
14. Did you start hormone replacement therapy (HRT) within the first 2 years of menopause or after receiving a hysterectomy?
Yes
No
Did you develop PD before you started HRT?
Yes
No
14c. What type of HRT have you tried?
15. Prior to being diagnosed with PD did you use any of these types of birth control?
Since you have been diagnosed with PD, have you continued using a pill birth control?
Yes
No
Since you have been diagnosed with PD, have you continued using a ring birth control?
Yes
No
Since you have been diagnosed with PD, have you continued using an arm implant birth control?
Yes
No
Since you have been diagnosed with PD, have you continued using a hormonal IUD?
Yes
No
Since you have been diagnosed with PD, have you continued using a copper IUD?
Yes
No
Since you have been diagnosed with PD, have you continued using a patch birth control?
Yes
No
16. I have experienced:
Did you experience difficulties with:
17. Did you have any of the following experiences prenatal, perinatal, or postnatal?
If you had eclampsia or pre-eclampsia, how did your PD symptoms change?
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
If you had diabetes during pregnancy, how did your PD symptoms change?
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
If you had a viral infection, how did your PD symptoms change?
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
If you had a bacterial infection, how did your PD symptoms change?
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
If you had depression/anxiety during pregnancy, how did your PD symptoms change?
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
If you had postpartum depression, how did your PD symptoms change?
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
If you had flair up migraines, how did your PD symptoms change?
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
Much better
Better
Stayed the same
Worse
Much Worse
Don't recall
Yes
No
N/A
If yes, did you stop taking your PD medication?
Yes
No
19. Have you ever been diagnosed with any of these disorders?
In what year were you diagnosed with polycystic ovarian syndrome?
If you don't recall type 0
In what year were you diagnosed with hypothyroidism?
If you don't recall type 0
In what year were you diagnosed with hyperthyroidism ?
If you don't recall type 0
In what year were you diagnosed with diabetes type I?
If you don't recall type 0
In what year were you diagnosed with diabetes type II?
If you don't recall type 0
In what year were you diagnosed with lupus?
If you don't recall type 0
In what year were you diagnosed with rheumatoid arthritis?
If you don't recall type 0
In what year were you diagnosed with migraines (no aura)?
If you don't recall type 0
In what year were you diagnosed with migraines (with aura)?
If you don't recall type 0
In what year were you diagnosed with irritable bowel syndrome (IBS)?
If you don't recall type 0
In what year were you diagnosed with crohn's disease?
If you don't recall type 0
In what year were you diagnosed with melanoma?
If you don't recall type 0
In what year were you diagnosed with hypertension?
If you don't recall type 0
In what year were you diagnosed with breast cancer?
If you don't recall type 0
Did you take hormonal therapy for breast cancer?
Yes
No
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