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Women’s Longevity Questionnaire

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Women’s Longevity Questionnaire with a self-rating score for various section

This questionnaire allows women to self-assess their health and identify areas of concern related to heart disease, stroke, cancer, fractures, and sexual health. It encourages proactive discussions with healthcare providers to improve overall health and longevity.

Women’s Longevity Diagnostics Screening Questionnaire

Women’s Longevity Diagnostics Screening Questionnaire

Heart Disease Risk

1. Family History of Heart Disease?
2. Blood Pressure: Have you ever been diagnosed with high blood pressure?
3. Cholesterol Levels:Have you ever had your cholesterol levels checked?
4. Smoking Status: Do you smoke or have you ever smoked?
5. Physical Activity:How often do you engage in physical activity?

STROKE RISK

6. Stroke History: Have you ever experienced a stroke or transient ischemic attack (TIA)?
7. Atrial Fibrillation: Have you ever been diagnosed with atrial fibrillation or irregular heartbeat?
8. Diabetes: Have you been diagnosed with diabetes or prediabetes?
9. Weight Management: Do you have a body mass index (BMI) over 25?

CANCER RISK

10. Family History of Cancer: Do you have a family history of breast, ovarian, or other cancers?
11. Breast Health: Have you had a mammogram in the past year?
12. Pap Smear: Have you had a Pap smear in the past 3 years?
13. Sun Protection: Do you use sunscreen regularly or take precautions against sun exposure?

FRACTURE RISK

14. Bone Health: Have you ever been diagnosed with osteoporosis or low bone density?
15. Calcium and Vitamin D Intake: Do you take calcium and vitamin D supplements?
17. Physical Activity: Do you engage in weight-bearing exercises (e.g., walking, running, resistance training)?

SEXUAL HEALTH RISK

18. Sexual Activity: Are you currently sexually active?
19. Satisfaction: On a scale of 1 to 10, how satisfied are you with your sexual health?
20. Discomfort or Pain: Do you experience any discomfort or pain during sexual activity?
21. Sexual Health Check-ups: Have you had a sexual health check-up in the past year?
27. Menopausal Status:

Scoring Instructions:

– Total Score Calculation: Add up the self-rating scores for each section.

– Score Interpretation:

  – 36-40: Excellent health and low risk.

  – 31-35: Good health with minor risks; consider preventive measures.

  – 26-30: Moderate risk; consider lifestyle changes and consult a healthcare provider.

  – 21-25: High risk; consult a healthcare provider for comprehensive evaluation.

  – 20 or below: Significant health risks; immediate consultation with a healthcare provider is recommended.

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