Operational definitions:

Adult Twins: Twins age 15 and above

No star: Applicable to female only
*Applicable for male and female twins
** Applicable for male only

Questions 37-45 will only be asked from those who are menopausal (females) or above 45 years of age (both males and females)

All the questions have code 1: Yes, Code 2: No, Code 9: Not applicable unless otherwise is stated

Race: Code 1: Malay, Code 2: Chinese, Code 3: Indian, Code 4: Others

Education : Code 1 : Illiterate, Code 2 : being able to read and write up to primary school, Code 3 : Secondary school, Code 4 : High school, Code 5 : University Degree and above, Code 9 : Not applicable (child).

Occupation : Code 1 : Student, Code 2 : Unemployed, Code 3 : Government sector, Code 4 : Private sector, Code 9 : Non applicable (Child)

Marriage status : Code 1 : Married, Code 2 : Single, Code 3 : Separated, Code 4 : Widowed

Blood group: Code 9: If they do not know their blood group

RH: Code 9: If they do not know their blood group

Gestational age : First ask “Were you born at 40 weeks of gestation (9 month) or earlier?” then ask “How early (how many weeks earlier)?” calculate how many weeks earlier, deduct from 40 weeks and write the number in the box provided.

Vaccination: Did they receive any vaccination during childhood?

Age of menarche: Ask this question only if the twin is female.

Menstruation: First ask “Do you currently have menstruation?” Code 1: yes, Code 2: No, 9: Not applicable (currently pregnant, currently on continuous hormones, currently menopause, child)
Duration (days): That is the duration of bleeding during menstruation (e.g. 3 , 5 or 7 days)
Interval (Days): that is the first day of last menstruation to the first day of the menstruation before that (e.g. 23, …28,…41 days). Number below 22 and above 42 should be clearly asked and stated.
Amount: low means spotting or changing one pad per day during menstruation on average; Normal means having a flow of blood or changing 2 to 3 pads per day during menstruation on average; high means excessive bleeding or having to change more than 3 pads per day on average

PMS: Ask “Do you have pain at lower back and abdomen during menstruation, abdominal balletomane, breast tenderness?” Code 1: Yes, Code 2: No, Code 9: Not applicable (child)

Age of marriage: If not applicable (child) code 9, if missing data code 99.

Age of first pregnancy: Only from female twins: Fist ask: Have you had pregnancy? If yes: fill up the age of first pregnancy, if No Code 0, if Not applicable (child, male) code 9, if missing data code 99.

G: Number of pregnancies P: Number of deliveries Ab: Number of abortions

Ch: Number of living children Boy: Number of boys Girl: Number of girls

Last delivery Normal C/S AS: Was your last delivery a normal vaginal delivery or Cesarean section or Assisted delivery (Vacuum, Forceps)?

Prenatal care: Ask “Did you get prenatal care?” (Did she go to hospital, clinic or private doctor to get prenatal care? If none, please circle “None”.

Breast feeding: Ask “Did you breast fed your baby?”

Gynecological problem: Ask “Did you have gynecological problems during last 5 years?” (e.g. bleeding, pelvic pain, vaginal infection… for which you have visited a doctor or intended to visit a doctor?

Amenorrhea : Ask “Do you have two or less menstruation per year only?”

Acne: Ask “Do you have acne on face, chest or back?”

Hirsutism: Ask“Do you have coarse dark hair on lip, chest, abdomen or thighs?”

Weight: Ask “What is your weight in kilogram?” Height: ask “What is your height in centimeter?”

Infertility: ask this question if twin (male or female) is 18 years old and above and married. Have you been diagnosed with infertility?

Family planning: Ask “ Do you or your partner use any family planning to prevent unwanted pregnancy?” (e.g. contraceptive pills, IUD, Condom, Natural method, Withdrawal method, tube legation, vasectomy).

Cancer: Have you been diagnosed with any cancer? Code 1: Breast cancer, code 2: Cervical cancer, Code 3: Any other gynecological cancer (e.g. uterus, ovary), Code 4: Non gynecological cancer, Code 5: Prostate cancer for male only Code 0: None.

Pap smear: Have you done pap smear during last 5 years?

Age of menopause: Only female and those above 30 years of age (since there might be cases of premature menopause). If they have responded to the previous question on irregular menstruation that means they are not menopausal. In that case there is no need to ask this question.

Hot flushes: Do you have hot flushes, getting hot and red in the face and neck area during day or night time.

Low libido: “Do you have low tendency to sexual desires?”

Dysparonia: This question is only for female: “Do you have pain during intercourse?”