Some of these change what your periods can tell us. Tick any that are true for you today.
A final period is defined by bleeding. Hormonal birth control, hormone therapy, pregnancy, breastfeeding, and some surgeries or treatments change or stop bleeding for their own reasons, so the dates can't be read the usual way. We'd rather know than guess.
These matter more than anything else on this form. If one is true, we say so first.
Bleeding after a year without periods, bleeding that lasts more than seven days, or soaking through a pad an hour are each a reason to be seen promptly, whatever else is going on. That's guidance from ACOG, the US obstetricians' college.
Five quick questions. No dates to remember.
Exact dates let us count the days and name the day twelve months lands on. You can add them over time.
Tick any that are true. These don't change the reading; they go on your Appointment Summary because the paperwork years and the sleepless years are often the same years.
Skip anything you don't know. None of this changes the reading of your dates; it goes on your page for your clinician.
Published formulas that could add a number. We only run one once we've checked every term against the paper it came from. Until then it says so.