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Rate Your PMS

How Severe Is Your PMS

Rate each symptom using the following scale:0 for no symptoms; 1 for mild symptoms;
2
for moderate symptoms; and 3 for severe symptoms.  

Mood swings
_______________
Depression/sadness
_______________
Tension/irritability 
_______________
Anxiety/nervousness
_______________
Anger/aggression/short temper
_______________
Crying spells
_______________
 
 
Water Retention
 
Swelling of extremities 
_______________
Tenderness, fullness of breasts
_______________
Abdominal bloating 
_______________
 
 
Food Cravings
 
Increased or decreased appetite
_______________
Cravings for sweets or salts
_______________
 
 
Pain
 
Abdominal cramping
_______________
Generalized aches and pains
_______________
Low back pain 
_______________
Headaches 
_______________
Fatigue 
_______________
Insomnia
_______________
Total
_______________
 
 
If your total score is 0-17, you have no more than mild PMS, 18-34 indicates moderate PMS, and 35-51 indicates severe PMS
 

Be sure and keep a copy of this survey for future comparison after 2 cycles on the Cycle Diet.

Source: Dr. Susan Thys-Jacobs, Calcium and PMS 1998

 

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