Premenstrual syndrome (PMS) refers to a wide range of symptoms that occur during the second half of the menstrual cycle (14 days or more after day one of the last menstrual period), and retreat 1 - 2 days after menses begins.
Beside each symptom are the following letters - A, B, C, & D. Decide which of the following categories fits you for EACH symptom; then tick the appropriate Option:
A
- if the symptom does NOT exist
B
- if the symptom is barely noticeable
C
- if the symptom inhibits your activities
D
- if the symptom alters your lifestyle.
Name & Surname
Part 1: EMOTIONAL PRE-MENSTRUAL SYMPTOMS EVALUATION:
A
B
C
D
1.
Angered Easily:
2.
Anxiety:
3.
Apathy, Disinterest in Life:
4.
Chocolate Craving:
5.
Confused, Uncertain:
6.
Depressed, Sad:
7.
Disassociation with Body:
8.
Guilt:
9.
Hopeless Feelings:
10.
Irritable, Tense:
11.
Loneliness:
12.
Low Self Esteem:
13.
Moodiness:
14.
Personality Change:
15.
Prone to Violent Outbursts:
16.
Resentful:
17.
Stressed Out Feelings:
18.
Dark circles under eyes:
Part 2: PHYSICAL PRE-MENSTRUAL SYMPTOMS EVALUATION:
A
B
C
D
1.
Abdominal Bloating:
2.
Absent Mindedness:
3.
Back Pain:
4.
Binge Eating, Food Cravings (Sweets, Salt, Chocolate):
5.
Breasts Tender / Swell:
6.
Constipation:
7.
Diarrhea:
8.
Edema (Swollen Ankles, Hands, etc):
9.
Fainting, Vertigo:
10.
Fatigue:
11.
General Body Discomfort:
12.
Headaches:
13.
Insomnia:
14.
Nausea:
15.
Skin Eruptions, especially at th Jaw Line:
16.
Weight Gain:
