Are you anemic (low iron)?
YesNo
Have you ever received a blood transfusion for anemia?
YesNo
Do you get heavy menstrual bleeding or period last more than a week?
YesNo
Painful menstrual cramps?
YesNo
Have you been trying to get pregnant for more than a year?
YesNo
Have you experienced multiple miscarriages?
YesNo
Fatigue and tiredness?
YesNo
Frequent urination?
YesNo
Pelvic pain and pressure?
YesNo
Bloating and constipation?
YesNo
Pain in the back and legs?
YesNo
Pain during sexual intercourse?
YesNo
