How heavy is your menstrual bleeding? *

Normal flow

Very light/short

Very heavy (need to change pads/tampons every 1–2 hours)

At what age did your periods start? *

Before 15 years

At 15–17 years

After 17 years / still irregular since beginning

Skin & Hair Symptoms

How often do you have acne outbreaks? *

Rarely / occasional pimples

Frequent (every month)

Persistent, severe acne

Do you have excess hair growth on the face/body (chin, chest, stomach, back)? *

None / very mild

Moderate (need to remove every few weeks)

Severe (need to remove weekly or more)

How often do you remove unwanted facial/body hair? *

Rarely

Every few weeks

Weekly or more often

Have you noticed scalp hair thinning? *

No

Mild thinning

Significant thinning / bald patches

Weight & Metabolism

How has your weight changed in the last 1–2 years? *

Stable

Gained slightly

Significant weight gain (especially belly fat)

How easy is it for you to lose weight with diet and exercise? *

Easy / normal

Difficult

Almost impossible

Have you ever been told you have high blood sugar, insulin resistance, or diabetes? *

No

Borderline / pre-diabetes

Yes, confirmed diabetes

Fertility & Hormonal Symptoms

Have you been trying to conceive? *

Not trying

Yes, <1 year without success

Yes, >1 year without success

Do you experience mood changes (anxiety, depression, irritability) linked to your cycle? *

Rarely

Sometimes

Often / severe

Have you noticed dark, velvety skin patches around your neck, armpits, or inner thighs? *

No

Mild patches

Prominent, visible patches

How often do you feel unexplained tiredness or low energy? *

Rarely

Sometimes

Almost daily

Has an ultrasound ever shown “polycystic ovaries”? *

No / Never checked

Maybe / uncertain

Yes, confirmed by doctor

Menstrual Health

Skin & Hair Symptoms

Weight & Metabolism

Fertility & Hormonal Symptoms