Follow-up Reproductive History Form and Dictionary
| Follow-up Reproductive History | ||
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| Variable / Field Name | Field Label | Choices, Calculations, OR Slider Labels |
|---|---|---|
| rep_hist2_adcid | Site: 39 ADCID | rep_hist2_ptid | Subject ID: PTID | rep_hist2_visitdate | Form Date: (Y-M-D) | rep_hist2_visitnum | Visit Number: 2 or up | rep_hist2_initials | Examiner's initials: INITIALS | rep_hist2_ent_date | Data Entry Date: (Y-M-D) | rep_hist2_ent_by | Data Entry By: | fu_repro_admin_sts | Administered Status | 1, 1 Yes | 95, 95 - No, Physical Problem | 96, 96 - No, Cognitive/Behavior Program | 97, 97 - No, Other Problem | 98, 98 - No, Verbal Refusal | 99, 99 - Not Administered | rep_hist2_text00 | Reproductive History (women only), follow-up visit | rep_hist2_q1 | 1. Since your last visit with us, have you had one or both ovaries removed? (Y/N/DK) (Skip, if this was previously answered as YES, two ovaries.) | 0, 0 No | 1, 1 Yes | 9, 9 Don't Know | rep_hist2_q1ai | 1ai. If ONE or DON'T KNOW, what was your age when your ovary was removed? (years) | rep_hist2_q1aii | 1aii. If TWO, both at the same time? (Y/N/DK) | 0, 0 No | 1, 1 Yes | 9, 9 Don't Know | rep_hist2_q1aiia | 1aii(A). If YES or DON'T KNOW, what was your age when your ovaries were removed? (years) | rep_hist2_q1aiib1 | 1aii(B1). If NO, what was your age when your first ovary was removed? (years) | rep_hist2_q1aiib2 | 1aii(B2). If NO, what was your age when your second ovary was removed? (years) | rep_hist2_q2 | 2. Since your last visit with us, have you had a hysterectomy (partial hysterectomy or total hysterectomy)? / (or, Have you ever had your uterus removed?) (Y/N/DK) (Skip, if this was previously answered as YES.) | 0, 0 No | 1, 1 Yes | 9, 9 Don't Know | rep_hist2_q2a | 2a. If YES, how old were you when you had a hysterectomy? (years) | rep_hist2_q2b | 2b. (For women who answered YES to question #4 and question #5): If YES, was this at the same time that (your ovary was removed)/ (your ovaries were removed)? (Y/N/DK) | 0, 0 No | 1, 1 Yes | 9, 9 Don't Know | rep_hist2_q3 | 3. Are you currently using (hormonal) birth control? (Y/N/DK) (Hormonal birth control refers to an estrogen or a progestin or both. These can be taken or delivered by mouth, by injection, by transdermal patch, by a vaginal ring, or by a subcutaneous implant. It does not include intrauterine devices or other forms of contraception. OK to assume "NO" for ages 60+.) | 0, 0 No | 1, 1 Yes | 9, 9 Don't Know | rep_hist2_q4 | 4. Since your last visit with us, have you used hormone therapy (menopausal hormone therapy)? (Y/N/DK) (Hormone therapy is an estrogen, with or without a progestogen, taken by mouth, or delivered by injection or transdermal patch. Include estrogen prescribed to prevent migraine headache. Do not include vaginal (topical) estrogen.) | 0, 0 No | 1, 1 Yes | 9, 9 Don't Know | rep_hist2_q4a | 4a. If YES, are you currently taking hormone therapy? (Y/N/DK) | 0, 0 No | 1, 1 Yes | 9, 9 Don't Know | rep_hist2_q4b | 4b. If YES, how old were you when you most recently started (or most recently restarted) hormone therapy? (years) | rep_hist2_q5 | 5. Are you still menstruating?/ (or, Have you had a menstrual period within the past 12 months?) (Y/N/DK/Not asked) (DON'T KNOW may apply when a woman started hormone therapy prior to a final menstrual period.) (Skip, if this was previously answered as NO and the participant is age 65 or older.) | 0, 0 No | 1, 1 Yes | 9, 9 Don't Know | 88, 88 Not asked | rep_hist2_q5a | 5a. If YES, have you had a menstrual period within the past 60 days? (Y/N/DK) | 0, 0 No | 1, 1 Yes | 9, 9 Don't Know | rep_hist2_q5b | 5b. If YES, would you describe your current menstrual cycle (menstrual periods) as 1) regular without a change in flow or length, 2) regular but with mild changes in flow or length, or 3) variable with a persistent, 7 or more day difference in the length of consecutive cycles (periods)? (Regular/ Mild changes/ Variable) | 1, 1 Regular: regular without a change in flow or length | 2, 2 Mild changes: regular but with mild changes in flow or length | 3, 3 Variable: variable with a persistent, 7 or more day difference in the length of consecutive cycles (periods) | rep_hist2_q5c | 5c. If NO, how old were you when you had your last period? (years) (This age must be at least 1 year less than the current age.) |