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Let’s hear from you!

Like all women, those with MS will face the inevitable experience of menopause. Adding multiple sclerosis to the mix spells turmoil, confusion and distress for many at this time of change. Please complete this questionnaire to share your experience with others in a similar life situation. Your response to the following questions may contribute to a planned publication on the topic of MS and Menopause.

Please consider this opportunity. For more information, you can get in touch with Ellen Karr at 988-0917/1-800-268-7582 or ellen.karr@mssociety.ca. Together we can achieve a successful outcome to this project.

MS and Menopause Questionnaire

Name:

Phone (home):

Address:

Phone (work):

City:

Phone (cell):

Postal Code:

Email:

By providing your email address, you consent to communicating via email and help the MS Society reduce mailing costs and preserve the environment.

I am a woman with MS who

is anticipating menopause

is currently going through menopause

has been through menopause

1. What are/were your greatest concerns regarding menopause as a woman living with MS?

2. What strategies would you try/have you tried to cope with this phase of your life?

3. What were the outcomes?

4. What would have helped you cope better?

5. Give an example or two of your menopause experience.

The Multiple Sclerosis Society of Canada is committed to handling any personal information we may collect in a professional, respectful and lawful manner. By providing the information, you hereby consent to the collection of your name and story for use by the MS Society of Canada, Manitoba Division for publication for the project “MS and Menopause”. While providing your name is optional, by sharing your story with the MS Society of Canada anonymously, you hereby consent to the utilization of your story by the MS Society of Canada for the project “MS and Menopause”

In accordance with the Society’s privacy policy, we will use very limited personal information (name, if you agree and your story) in the publication “MS and Menopause”. A copy of our privacy policy may be obtained at the MS Society of Canada, 175 Bloor Street East, Suite 700, Toronto ON M4W 3R8 or at www.mssociety.ca. If at any time you have questions about your personal information, please contact the Manitoba Division Privacy Officer at 1-800-268-7582 or at priv-manitoba@mssociety.ca.

By checking this box, you agree you have read this waiver. You understand and accept its terms.

If you have any questions about this questionnaire or this project, please contact:

Ellen Karr, Client Services Coordinator
Phone: (204) 988-0917
Toll Free: 1-800-268-7582
Fax: (204) 988-0915
ellen.karr@mssociety.ca

Our Mission :
To be a leader in finding a cure for multiple sclerosis and enabling people affected by MS to enhance their quality of life.

Manitoba Division
Multiple Sclerosis Society of Canada
Suite 100-1465 Buffalo Place
Winnipeg, Manitoba R3T 1L8

To locate the MS Society office near you, please select the appropriate chapter:

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