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| Section 1. Menstrual-cycle-related signs and symptoms (rating scale) |
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| 1.1 The problem of blood in the uterus |
| 1. You have thick texture menstrual blood. |
| 2. Your menstrual blood looks like egg whites. |
| 3. Your menstrual blood smells stronger than usual or smells like rotten meat. |
| 4. You have a lot of menstrual blood clots which are released every day, or large-size clots (greater than or equal to 2 centimeters). |
| 5. You have a lot of vaginal discharge that you need to put on a sanitary pad and your vaginal discharge is eggy, clear, stretchy, or thick white. |
| 6. Your vaginal discharge is an abnormal color with a bad smell (abnormal color: yellow, green, brown or blood). |
| 7. Before the menstrual period, you have vaginal discharge and vaginal itching. |
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| 1.2 Irregular menstrual blood |
| 8. You have light or heavy menstrual bleeding throughout the cycle (using less than 2 pads per day or more than 4 pads per day). |
| 9. Your menstrual blood color is pale red, bright red, orange, dark red, dark brown, or black. |
| 10. In one period, you have many colors of menstrual blood. |
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| 1.3. The musculoskeletal system |
| 11. Hot and cold flushes or fever |
| 12. Muscle pain/lower back pain |
| 13. Joint pain/bone pain |
| 14. Fatigue |
| 15. Breast pain/tender breasts |
| 16. Abdominal cramps |
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| 1.4. The digestive system (intestine and mesentery) |
| 17. Loose/watery stools five or six times a day |
| 18. Colic in the abdomen or flanks |
| 19. Abdominal bloating/abdominal discomfort |
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| 1.5 The heart (mind aspect) |
| 20. Waking up with a fright/insomnia |
| 21. Irritability and/or anger |
| 22. Depression and/or crying |
| 23. Anxiety and/or tension |
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| Section 2. Associated factors (rating scale) |
| 2.1. Emotion and feeling |
| 24. You feel anxious or worried. |
| 25. You are irritable or angry. |
| 26. You are bored, depressed, or in despair. |
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| Section 2. Associated factors (rating scale) |
| 2.2. Types of drink |
| 27. You like to drink ice-beverages or frappe. |
| 28. You like to drink caffeine beverages (e.g., chocolate, tea, carbonated beverage, energy drinks, coffee). |
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| 2.3. Types of food |
| 29. You like to eat strong-flavored foods, e.g., extremely spicy, extremely sour. |
| 30. You eat preserved food and/or uncooked food, e.g., fruit preserves, sashimi, and medium to raw meat. |
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| 2.4. Environment |
| 31. You work or stay in a bad environment for a long time a day (in the area too hot or cold/exposed to or inhaling chemicals). |
| 32. In one day, you must enter and exit the area with temperature differences (hot and cold). |
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| 2.5. Behaviors and health problems |
| 33. You work hard (using a lot of energy or muscle power). |
| 34. You have sleep problems, e.g., insomnia, waking up with a fright in the middle of the night. |
| 35. You have constipation. |
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| Section 2. Associated factors (multiple choice) |
| 2.6. Personal data |
| 36. How old are you? |
| 37. Date and time of birth |
| 38. Weight and height |
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| 2.7. Medical history |
| 39. What is your health problem or underlying disease? |
| 40. Have you ever had an accident that injured your lower back or lower abdomen? |
| 41. Have you ever had abdominal surgery? |
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| 2.8. Ob-gynecologic history |
| 42. How old were you when your first period start? |
| 43. Have you ever given birth to a child? |
| 44. What postpartum care did you have? |
| 45. Have you ever miscarried? |
| 46. Have you ever had a curettage? |
| 47. Have you ever used hormonal birth control? |
| 48. Has your grandmother or mother had a menstrual disorder history? |
| 49. When did your menstrual symptoms first occur? |
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