Dysmenorrhea And Pmt Symptomatology Page 6
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8DYSMENORRHEA AND PMT SYMPTOMATOLOGY
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NAME: __________________________________________ CYCLE _____________________________________
Grading of menses
0-none
3-heavy
Grading of symptoms
1-slight
4-heavy and clots
0-none
2-moderate
1-mild-present but does not interfere with activities
2-moderate-present and interferes with activities but not disabling
MONTH: ________________________________________ 3-severe-disabling
DAY OF CYCLE
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RATE
MENSES
I.
PMT-A
Nervous tension
Mood swings
Irritability
Nervous tension
Anxiety
II.
PMT-C
Headache
Craving for sweets
Increased appetite
Heart pounding
Fatigue
Dizziness or faintness
III. PMT-D
Depression
Forgetfulness
Crying
Confusion
Insomnia
IV. PMT-H
Weight gain
Swelling of extremities
Breast tenderness
Abdominal bloating
V. PMT-P
General aches / pains
Itching
VI. DYSMENORRHEA
Cramps (abdominal)
Hot flushes
Nausea / vomiting
Diarrhea
Backache
Chest pain
VII.
Basal Body Temperature
VIII.
Basal Weight
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