PMDD Screening and Premenstrual Health Assessment
This assessment helps identify symptoms associated with Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS that significantly affects mood, physical health, and daily functioning. Please answer based on your experiences during the week before your period starts over the last few cycles.
In the week before your period, do you feel intense sadness or hopelessness?
Do you experience marked anxiety, tension, or feeling “on edge” before menstruation?
Do you notice sudden tearfulness or increased sensitivity to rejection?
Do you feel persistent and marked irritability or anger?
Do you experience increased conflicts with people around you before your period?
Do you lose interest in usual activities like work, school, or hobbies?
Do you find it difficult to concentrate or maintain focus?
Do you experience fatigue, lack of energy, or easy tiring?
Do you notice a marked change in appetite, overeating, or specific food cravings?
Do you experience hypersomnia (sleeping too much) or insomnia?
Do you feel overwhelmed or like things are out of control?
Do you experience physical symptoms like breast tenderness or swelling?
Do you experience joint or muscle pain during the premenstrual phase?
Do you experience bloating or a sensation of weight gain?
Do these symptoms significantly interfere with your work or school performance?
Do these symptoms interfere with your social activities or relationships?
Do you notice that these symptoms disappear within a few days after your period starts?
Have you felt that your mood swings are unpredictable during this phase?
Do you find yourself withdrawing from social contact before your period?
Do you feel a sense of “brain fog” or mental sluggishness?
Confidential · Not stored · Not a medical diagnosis