How often do you experience urinary incontinence? Never Rarely, less than once a month Occasionally, a few times a month Frequently, a few times a week Daily None Do you notice a correlation between your incontinence and certain activities (e., coughing, sneezing, exercising)? Never Rarely, less than once a month Sometimes, a few times a month Often, a few times a week Always None Have you experienced any hormonal changes recently (e.g., irregular periods, hot flashes, night sweats)? No Mildly Significantly Extremely None Do you feel an urgent need to urinate more frequently than usual? Never Rarely, less than a once a month Sometimes, a few times a month Often, a few times a week Always None Do you wake up multiple times at night to urinate? Never Rarely, less than a once Sometimes, a few times Often Always None Have you noticed any changes in your bladder control since entering menopause or perimenopause? No Slightly Moderately Significantly Drastically None Do you experience a sudden, strong urge to urinate that makes it difficult to reach the bathroom in time? Never Rarely Sometimes Often Always None 1 out of 2 Name Email Phone Time's up
