Enrollment - pausitive health

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How would you like personalized guidance that’s flexible and customizable based on where you are in your menopause journey?

Get started by telling us about your menopause symptoms and areas of interest so you can make this stage of life easier, starting today!

Please answer all questions completely before submitting. Expect to spend around 5-10 minutes. If you must step away, do not close out the survey so you can resume where you left off.

"*" indicates required fields

On a scale of 1-5, with 1 being poor and 5 being excellent, how would you rate your menopause journey so far?*

Please select the statement that applies the most at this point in your menopause journey?*

Looking forward to it

Embracing the change

Unprepared

Dreading it

Afraid of what lies ahead

Have mixed feelings

Other

You chose "Other", please specify:

Which of the following symptoms apply to you at this time? (For symptoms that do not apply, please select “None”).*

Symptoms

None

Mild

Moderate

Severe

Extremely Severe

None

Mild

Moderate

Severe

Extremely Severe

Anxiety*

(inner restlessness, feeling panicky)

Brain “fog”*

(general decrease in performance, impaired memory, decrease in concentration, forgetfulness)

Depressive mood*

(feeling down, sad, on the verge of tears, lack of drive, mood swings)

Fatigue/exhaustion*

GI problems*

(gas, bloating, change in bowel habits, nausea, vomiting, indigestion, GI reflux)

Hair changes*

(hair thinning and shedding, hair loss, dry hair)

Heart sensations*

(unusual awareness of heartbeat, skipping beats, heart racing, palpitations)

Hot flashes, night sweats, cold flashes*

Irritability*

(feeling nervous, inner tension, feeling aggressive/anger/rage)

Joint and muscular discomfort*

(pain in your muscles, legs, and/or joints)

Sexual problems*

(change in sexual desire, in sexual activity and satisfaction, difficulty getting an orgasm)

Skin changes*

(dry, itchy, prickly or burning sensation) and nail changes (brittle, thin)

Sleep problems*

(difficulty in falling asleep, difficulty in sleeping through the night, waking up early)

Stress*

Urinary tract problems*

(frequent UTIs, need to get to the bathroom quickly, more frequent urination, bladder leakage)

Vaginal Dryness*

(sensation of dryness, burning, itching, pain in the vagina, pain with sexual intercourse, bleeding after sex)

Weight gain*

Hidden

Symptom Score

Hidden

MRS Score

Other Symptoms

Have you had your period within the last 12 months?*

Yes

No; reached menopause

No; had surgery

No; on birth control

No; had cancer treatment

No; other

What is the reason that your period stopped?*

What age were you when your period had stopped for 12 consecutive months?*

At what age did you have surgery?*

Are you still undergoing cancer treatment?

Yes

At what age did your cancer treatment end?

Are you currently using Hormone Therapy (HT)?*

Yes

Used HT for a while but stopped (side effects/complications)

Used HT for a while but stopped (no longer need it)

No, by choice

No, for medical reasons

No, not needed at this time

Customize Your Messages

You will receive Menopause 101, which provides educational information and guidance. However, every menopause journey is unique.

To customize this experience for you, tell us about areas where you need help or want to learn more, e.g., sleep, brain fog, eating patterns that can make symptoms better as well as foods that can trigger symptoms. You can also learn about the impact race/ethnicity, gender identity, and sexual orientation can have on symptoms and risks for certain conditions.

You’ll get:

2-5 messages per week, depending on your selections, with in-depth content on areas of interest
Flexibility to adjust your content focus every 3 months
You can stop content tracks at any point by texting STOP
Access to additional current and future pausitive health concierge services that can help you manage symptoms
Woven into this program is Music as Medicine – a library of music scientifically proven to help in areas like mood swings, sleep issues, and a negative mindset about menopause

The next 3 questions ask about additional in-depth content you would like to receive. We recommend you select no more than 3 areas so you can learn and focus on taking action without getting overwhelmed.

Please tell us which topics you would like to receive content on.*

Menopause 101
Information everyone should know about menopause as well as some of the special features offered by pausitive health.

Nutrition and weight management
Clinically-validated assessment and guidance to help you manage your weight, keep up your energy, and incorporate healthy eating habits to minimize menopause symptoms.

Physical activity
Movement and physical activity action steps to help with mental and physical health and weight management.

Emotional well-being, mindset and mental health
Learn relaxation techniques, develop coping skills and access music tracks scientifically proven to help emotional (and physical) well-being.

Brain fog and brain health
Clinically-validated brain health education and exercises from the Center for Brain Health at the University of Texas at Austin to improve the way you use your brain to reduce brain fog, improve focus and memory, and support brain health.

Sleep management
Learn about sleep hygiene, impact of food/caffeine/alcohol, brain-wave approaches (binaural beats), cognitive behavioral therapy (CBT), yoga, meditation (including progressive muscle relaxation, breathing, body scan), and other techniques to help get enough high-quality sleep.

Non-hormonal options
Alternative approaches, lifestyle options, mind-body therapies and movements, music, herbal medicine and non-hormonal medication.

Prescription medication options
Hormone Therapy (HT) and non-HT prescription medications.

Research to date has observed some potential differences in the menopause transition in certain populations (compared to the white women+ population). Are you interested in receiving content about the ways the menopause journey might be experienced differently by some individuals who belong to certain groups?

Select ALL that apply

Asian

Black/African American

Hispanic/Latina

Indigenous/Native American

Native Hawaiian or Pacific Islander

Are you interested in receiving content about the potential unique challenges of the menopause journey for the LGBTQIA+ community?*

Yes

Demographics

Name*

First Last

What do you like to be called (nickname)?

Email address*

Receive Newsletter

I would like to receive the pausitive health monthly newsletter at this email address. I understand that I may unsubscribe at any time.

Mobile number*

You will receive messages from 43386 that will guide you through the program. Message & data rates may apply according to your carrier plan. You may unsubscribe at any time by replying STOP and get program help by replying HELP. All of your information will be protected.

Date of Birth*

Zip code*

Who provided you with access to enroll in this program?*

You chose “Other”. Please specify?

Which of these companies are you affiliated with? Please start typing the name to narrow down the list. If you are not affiliated with any, select None.*

Gender

What gender were you assigned at birth?*

Male

Female

I prefer not to answer

Do you think of yourself as*

Female

Male

Neither exclusively male nor female

Transgender man/trans man

Other/additional gender category (or other)

I prefer not to answer

You chose "Other", please specify:

Race and Ethnicity

Race*

Select all that apply

Asian

Black or African American

Native American or Alaskan Native

Native Hawaiian or Other Pacific Islander

White

Other

I prefer not to answer

You chose "Other", please specify:

Ethnicity*

Select all that apply

Hispanic/Latina

Not Hispanic/Latina

Other

I prefer not to answer

You chose "Other", please specify:

One Last Thing

How did you hear about this program?*

Select all that apply

Employer communication

Friend/co-worker

Health plan communication

Newsletter

pausitive health website

Webinar

Social Media

Other

You chose "Other", please specify:

Is there anything else you’d like to tell us about your journey?

Accept Terms*

I accept the Privacy Policy, Terms, and Conditions. I understand that this program is a self-care program and is not a substitute for professional medical advice or treatment. I will always consult with a physician/healthcare professional on matters concerning my medical care, diagnosis, and treatment.

Receive Newsletter*

I agree to receive 3-7 messages/week related to menopause management from the number 43386. In addition, I will be signed up to for pausitive health Chat (ph Chat) which will allow me to chat via text with a program support person if I have any issues or concerns/comments about this program. I may also receive occasional messages from ph Chat from the number 833-945-5448.

Hidden

Receive Newsletter - No

At the current time and this point of development, the pausitive health concierge program is intended for use by only residents of the U.S.

Let's Get Started

Customize Your Messages

Demographics

Gender

Race and Ethnicity

One Last Thing