Menstrual History


Keep a history of your heavy periods.

If you’re concerned about abnormal uterine bleeding or other problems with your cycle, it’s time to talk to your doctor. Not sure where to start? Visit our Doctor Discussion Guide for tips and ideas.

Menstrual History Results


Your answers indicate you may benefit from an endometrial ablation treatment like Her Option In-Office Cryoablation Therapy.

The best way to take control of your heavy periods is to talk to your doctor. Tell him or her about the way abnormal uterine bleeding affects your life. For better insight into your symptoms, share these results at your next visit.

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The more information you can provide for your doctor, the better. Use this form to keep track of your periods, then print it out and take it to your next appointment.

1. How many consecutive days do you bleed per cycle?
days
2. How many days do you bleed per month?
days
3. *How regular is your menstrual bleeding?
4. *What is the duration of your menstrual bleeding
5. *How frequent is your menstrual bleeding?
6. *How would you describe the volume of your menstrual bleeding?
7. When did your heavy periods begin?
8. Have you ever had a post-partum hemorrhage
9. Have you ever had bleeding associated with a surgery?


Additional printable discussion materials include our Heavy Bleeding Quiz, Doctor Discussion Guide and Her Option Information Sheet.

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*Ian S. Fraser, M.D., Hilary O.D. Critchley, M.D., Malcom G. Munro, M.D., and Michael Broder, M.D. (Writing Group for this Menstrual Agreement Process). International definitions of abnormal menstrual bleeding. Fertil Steril, Vol. 87, No. 3, March 2007