Menopause Self Assessment- Form

Free Self Assessment

Could Perimenopause or Menopause be affecting your health?

Hormonal changes during perimenopause and menopause can affect many areas of your physical, emotional, and sexual well-being.
Complete this quick 2-minute self-assessment to see if our care programs may be right for you.

This assessment is for informational purposes only and does not provide a medical diagnosis.

Women’s Health Assessment Form

Step 1 of 12 - Location

Do you currently live in Ontario?(Required)

Yes

Program Currently Available in Ontario Only

Our virtual menopause programs are currently available to Ontario residents only.

Please consult a healthcare provider in your province for support.

Learn More About Women’s Health Services

Are you 39 years of age or older?(Required)

Yes

Perimenopause commonly begins between ages 40–50, although symptoms can occur earlier for some women.

In-Person Medical Assessment Recommended

While some symptoms may still be related to hormonal changes, we recommend an in-person medical assessment to rule out other possible causes and determine the most appropriate care.

Learn More About Women’s Health Services

Have you noticed any changes in your menstrual periods?(Required)

Yes

Are you experiencing hot flashes or night sweats?(Required)

Yes

Hot flashes may feel like: Sudden warmth spreading through your face, neck, or chest, Flushing or redness, Sweating during the day, Waking up overheated or drenched in sweat at night

Have you noticed vaginal dryness, discomfort, or changes in your sexual health?(Required)

Yes

This may include: Vaginal dryness Burning or irritation, Pain during intimacy, Lower sexual desire, Changes in sexual satisfaction

Are you experiencing bladder concerns or urine leakage?(Required)

Yes

Have you noticed new or worsening emotional changes?(Required)

Yes

This may include: Increased anxiety, Irritability, Mood swings, Feeling overwhelmed, Low mood or depression.

Have you recently developed sleep difficulties?(Required)

Yes

This may include: Difficulty falling asleep, Waking frequently during the night, Waking too early, Feeling tired despite sleeping, Sleep disrupted by hot flashes or night sweats.

Have you noticed new or worsening challenges with weight, nutrition, or metabolic health?(Required)

Yes

This may include: Weight gain despite maintaining your usual habits, Increased abdominal weight, Difficulty losing weight, Increased cravings, Concerns about blood sugar, cholesterol, or overall metabolic health

Need more information? We're here to help. If you'd like to learn more about our women's health programs or have any questions, complete the contact form. A member of our team will reach out to discuss your assessment, answer any questions you may have, and provide more information about our women's health services.

Name(Required)

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Email(Required)

Phone(Required)

Consent(Required)

I consent to My Compass Health collecting and using my responses to assess which women’s health service may be suitable and to contact me regarding next steps.

Menopause Care Program Recommended

Based on your responses, some of your symptoms may be related to perimenopause or menopause.

Our Menopause Care Program provides comprehensive assessment, treatment planning, symptom management, and ongoing support from experienced healthcare professionals.

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