Study ID
Item
Study ID
integer
C2826693 (UMLS CUI [1])
Study site name
Item
Study site name
text
C2825164 (UMLS CUI [1])
Subject ID
Item
Subject ID
integer
C2348585 (UMLS CUI [1])
Item
1. Have you ever given birth or fathered a child? (Include current pregnancy and any pregnancies that resulted in early pregnancy loss, whether by choice or not)
text
C0032961 (UMLS CUI [1])
Code List
1. Have you ever given birth or fathered a child? (Include current pregnancy and any pregnancies that resulted in early pregnancy loss, whether by choice or not)
CL Item
Yes (Please go to the next question) (1)
CL Item
No (Women, please go to question 3) (2)
CL Item
Unknown (Stop, you are finished) (3)
Item
1. Are you of child-bearing potential?
text
C1960468 (UMLS CUI [1])
Code List
1. Are you of child-bearing potential?
Item
2. Have you ever had a menstrual period?
text
C0025329 (UMLS CUI [1])
Code List
2. Have you ever had a menstrual period?
CL Item
no (If No, you are finished) (2)
menstrual period
Item
a. If Yes, what age was your first period?
text
C0025329 (UMLS CUI [1])
Item
3. Do you use any forms of contraception (periods may be regular or irregular)?
text
C0700589 (UMLS CUI [1])
Code List
3. Do you use any forms of contraception (periods may be regular or irregular)?
CL Item
yes ( If Yes, indicate all forms of contraception used (choose all that apply)) (1)
Combined Oral Contraceptives
Item
Oral contraceptives – combined pill (“the pill”)
boolean
C0009906 (UMLS CUI [1])
Progestogen only oral contraceptive
Item
Oral contraceptives – progestin-only pill (“minnmi- pill”)
boolean
C0420857 (UMLS CUI [1])
Transdermal patch
Item
Transdermal patch (i.e., Ortho Evra)
boolean
C0991556 (UMLS CUI [1])
Depo-Provera injections or shots
Item
Shot/injection (i.e., Depo-Provera)
boolean
C3842800 (UMLS CUI [1])
Vaginal ring
Item
Vaginal ring (i.e., NuvaRing)
boolean
C0042260 (UMLS CUI [1])
Mirena
Item
Implantable devices with hormone (i.e., ParaGuard, Mirena)
boolean
C0591811 (UMLS CUI [1])
Abstinence
Item
Abstinence
boolean
C3843422 (UMLS CUI [1])
contraceptive methods
Item
None of these
boolean
C0700589 (UMLS CUI [1])
Item
4. Are you currently pregnant?
text
C0549206 (UMLS CUI [1])
Code List
4. Are you currently pregnant?
date pregnancy
Item
a. If Yes, indicate your due date:
date
C0742974 (UMLS CUI [1])
menopause
Item
5. Do you believe you are currently experiencing menopause?
boolean
C0025320 (UMLS CUI [1])
last menstrual period
Item
a. If Yes, indicate the approximate date of your last menstrual period:
date
C0425932 (UMLS CUI [1])
hormonal therapy
Item
b. Have you taken hormonal therapy?
boolean
C0279025 (UMLS CUI [1])
hormonal therapy
Item
i. If Yes, specify name of hormonal therapy taken:
text
C0279025 (UMLS CUI [1])
start date End Date hormonal therapy
Item
ii. If Yes, indicate which years you started and stopped hormonal therapy:
text
C0808070 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
C0279025 (UMLS CUI [1,3])
Item
6. Are you post-menopausal?
text
C0232970 (UMLS CUI [1])
Code List
6. Are you post-menopausal?
Item
a. If Yes, indicate cause:
text
C0232970 (UMLS CUI [1,1])
C0020699 (UMLS CUI [1,2])
C3665472 (UMLS CUI [1,3])
Code List
a. If Yes, indicate cause:
CL Item
Surgical (complete hysterectomy – ovaries and uterus removed), (2)
CL Item
Surgical (partial hysterectomy – only uterus removed) (3)
CL Item
Medications or chemotherapy (4)
date hysterectomy
Item
Date of hysterectomy
date
C0011008 (UMLS CUI [1,1])
C0020699 (UMLS CUI [1,2])
Item
7. Any other known hormone-related/endocrine syndromes or disorders?
text
C0014130 (UMLS CUI [1])
Code List
7. Any other known hormone-related/endocrine syndromes or disorders?
Item
a. If Yes, specify:
text
C0014130 (UMLS CUI [1])
Code List
a. If Yes, specify:
CL Item
Polycystic ovary syndrome (1)
CL Item
Hyperthyroidism (2)
CL Item
Cushing’s syndrome (3)
CL Item
Other, specify (4)
Other
Item
Other
text
C0205394 (UMLS CUI [1])