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PMS Symptoms Checklist
Our PMS symptoms checklist will help to evaluate your severity of PMS and need for treatment.
Irritability
not experienced
experienced mildly
experienced moderately
experience severely
Anxiety
not experienced
experienced mildly
experienced moderately
experience severely
Tension
not experienced
experienced mildly
experienced moderately
experience severely
Mood Swings
not experienced
experienced mildly
experienced moderately
experience severely
Hostility, Anger
not experienced
experienced mildly
experienced moderately
experience severely
Depression
not experienced
experienced mildly
experienced moderately
experience severely
Sadness, Crying Spells
not experienced
experienced mildly
experienced moderately
experience severely
Confusion
not experienced
experienced mildly
experienced moderately
experience severely
Forgetfulness, Decreased Alertness/Concentration
not experienced
experienced mildly
experienced moderately
experience severely
Clumsiness
not experienced
experienced mildly
experienced moderately
experience severely
Fluid Retention
not experienced
experienced mildly
experienced moderately
experience severely
Backache
not experienced
experienced mildly
experienced moderately
experience severely
Menstrual Cramps
not experienced
experienced mildly
experienced moderately
experience severely
Abdominal Bloating
not experienced
experienced mildly
experienced moderately
experience severely
Breast Tenderness/Swelling
not experienced
experienced mildly
experienced moderately
experience severely
Headache/Migraines
not experienced
experienced mildly
experienced moderately
experience severely
Joint Pain/Muscle Spasms
not experienced
experienced mildly
experienced moderately
experience severely
Food Cravings (alcohol, carbohydrates, sweets)
not experienced
experienced mildly
experienced moderately
experience severely
Increase in Appetite/Weight Gain
not experienced
experienced mildly
experienced moderately
experience severely
Fatigue/Lethargy
not experienced
experienced mildly
experienced moderately
experience severely
Dizziness/Fainting
not experienced
experienced mildly
experienced moderately
experience severely
Decreased Self-Esteem
not experienced
experienced mildly
experienced moderately
experience severely
Sleep Disturbances
not experienced
experienced mildly
experienced moderately
experience severely
Stomach Upset/G.I. Complications/Changes in Bowel Movements
not experienced
experienced mildly
experienced moderately
experience severely
Acne
not experienced
experienced mildly
experienced moderately
experience severely
Panic Attacks
not experienced
experienced mildly
experienced moderately
experience severely
Cold Sores
not experienced
experienced mildly
experienced moderately
experience severely
Sinus Problems/Allergies
not experienced
experienced mildly
experienced moderately
experience severely
Delany - PMS Checklist
739 Irving Avenue - Suite 640 Syracuse, NY 13210 Tel: 315-478-1158 - Fax: 315-478-3014
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