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PMS Questionnaire

PMS Questionnaire

PMS Questionnaire for Women

Step 1 of 3

The Premenstrual Symptoms Screening Tool for Adolescents PSST-A

(Please choose the appropriate box)

Do you experience some or any of the following premenstrual symptoms which start before your period and stop within a few days of bleedings?

1. Anger / Irritability(Required)
2. Anxiety / Tension(Required)
3. Tearful / Increased sensitivity to rejection(Required)
4. Depressed mood / Hopelessness(Required)
5. Decreased interest in work activities(Required)
6. Decreased interest in home activities(Required)
7. Decreased interest in social activities(Required)
8. Difficulty Concentrating(Required)
9. Fatigue / Lack of energy(Required)
10. Overeating / Food cravings(Required)
11. Insomnia(Required)
12. Hypersomnia (needing more sleep)(Required)
13. Feeling overwhelmed or out of control(Required)
14. Physical symptoms (including breast tenderness, headaches, join/muscle pain, bloating, and weight gain)(Required)

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