Research.net Powered Online Survey

Welcome to MindMate Research!

Health research changes people’s lives every day. Researchers still need your help. Many studies end early because there are not enough volunteers. We want to advance research and help by matching you with research studies. More information about the eligibility criteria:

- Female

- Aged 18 - 49

- If you qualify and complete the study you may be reimbursed for time and travel.

Your name and contact information will not be shared and your answers will remain confidential. We will not use your information for any purpose other than to screen you for potential participation in this research study.

Question Title

1. Have you been diagnosed with endometriosis by a doctor?

Yes

I'm not sure

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2. If you answered yes to question #1, are you able to obtain a surgical report?

Yes

N/A

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3. Do you have regular menstrual cycles?

Yes

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4. Have you given birth within the last 6 months or had a miscarriage/abortion in the last 3 months?

Yes

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5. Have you undergone any of the following surgical procedures?

Hysterectomy

Bilateral oophorectomy

Any procedure that might interfere with gastrointestinal motility

Any major abdominal surgery

None of the above

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6. Have you undergone tubal sterilization which was performed with ESSURE™?

Yes

I'm not sure

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7. Have you had an endometrial ablation that resulted in the absence of menstruation?

Yes

I'm not sure

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8. Have you received treatment or are you currently receiving treatment with any of the following medications?

Gonadotropin-releasing hormone antagonists - in the last 3 months

Gonadotropin-releasing hormone agonist injections/3-month depot injections - in the last 3-6 months

Danazol - in the last 3 months

Oral contraceptives and other sex hormones - in the last month

Depot contraceptives - in the last 10 months

Selective Progesterone Receptor Modulators (SPRMs) - in the last 3 months

Selective Estrogen Receptor Modulators (SERMs) - in the last 3 months

Aromatase inhibitors - in the last 3 months

Systemic glucocorticoid treatments for acute diseases - in the last month

In situ IUD with progestogen - in the last month

None of the above

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9. Do you have severe to moderate pelvic pain with menses or moderate to severe pelvic pain at other times in cycle?

Yes

I'm not sure

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10. Have you previously had a failure to respond to prior treatment with GnRH agonists or GnRH antagonists for endometriosis?

Yes

I'm not sure

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11. Do you currently use any means of birth control?

If yes (please specify)

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12. Do you suffer from any of the following conditions?

HIV

Osteoporosis or any metabolic bone disease

Viral Hepatitis serology

Uterine bleeding of an undiagnosed cause

Severe scoliosis

History of blood clots in the legs or lungs

Heart Disease

Stroke

Breast Cancer

Estrogen related cancer (i.e. melanoma)

Migraines with aura

Liver disease

Abnormal pap smear in the last year

Any other causes of pelvic pain other than Endometriosis

Bone disease

None of the above

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13. Do you have a history of drug or alcohol abuse in the last 6 months?

Yes

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14. Have you taken any experimental drug within the last 12 months?

Yes

I'm not sure

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15. Are you pregnant or plan to become pregnant in the next 12 months?

Yes

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16. How tall are you in feet and inches?

Feet

Inches

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17. How much do you weigh in pounds?

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18. What is your date of birth (please use the following format MM/DD/YYYY)?

What happens next?

Our research partner will email or call you to complete your assessment and answer any questions you may have. This assessment is free and confidential, and you are under no obligation to participate in the study.

Question Title

1. Have you been diagnosed with endometriosis by a doctor?

Question Title

2. If you answered yes to question #1, are you able to obtain a surgical report?

Question Title

3. Do you have regular menstrual cycles?

Question Title

4. Have you given birth within the last 6 months or had a miscarriage/abortion in the last 3 months?

Question Title

5. Have you undergone any of the following surgical procedures?

Question Title

6. Have you undergone tubal sterilization which was performed with ESSURE™?

Question Title

7. Have you had an endometrial ablation that resulted in the absence of menstruation?

Question Title

8. Have you received treatment or are you currently receiving treatment with any of the following medications?

Question Title

9. Do you have severe to moderate pelvic pain with menses or moderate to severe pelvic pain at other times in cycle?

Question Title

10. Have you previously had a failure to respond to prior treatment with GnRH agonists or GnRH antagonists for endometriosis?

Question Title

11. Do you currently use any means of birth control?

Question Title

12. Do you suffer from any of the following conditions?

Question Title

13. Do you have a history of drug or alcohol abuse in the last 6 months?

Question Title

14. Have you taken any experimental drug within the last 12 months?

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15. Are you pregnant or plan to become pregnant in the next 12 months?

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16. How tall are you in feet and inches?

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17. How much do you weigh in pounds?

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18. What is your date of birth (please use the following format MM/DD/YYYY)?

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19. What is your first name?

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20. What is your last name?

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21. What is your email?

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22. What is your phone number?

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23. What is your ZIP/Postal code?

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24. What is a good time for the researcher to contact you?

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25. Anything else you would like to tell the research team?