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 |
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| Depression/sadness |
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| Tension/irritability |
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| Anxiety/nervousness |
_______________
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| Anger/aggression/short temper |
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| Crying spells |
_______________
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| Water Retention |
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| Swelling of extremities |
_______________
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| Tenderness, fullness of breasts |
_______________
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| Abdominal bloating |
_______________
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| Food Cravings |
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| Increased or decreased appetite |
_______________
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| Cravings for sweets or salts |
_______________
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| Pain |
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| Abdominal cramping |
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| Generalized aches and pains |
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| Low back pain |
_______________
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| Headaches |
_______________
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| Fatigue |
_______________
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| Insomnia |
_______________
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| Total |
_______________
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| 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 | |
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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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