PMDD/PME Self-Screen Tool

1

User Location

2

The following quiz is based on a self-screening quiz available through the University of Pennsylvania Health System Premenstrual Syndrome Program. It will help determine if you may be living with Premenstrual Dysphoric Disorder (PMDD), Premenstrual Exacerbation (PME) of an underlying disorder, or Premenstrual Syndrome (PMS).

This self-screen is for informational purposes only and is not intended to replace the care of a medical practitioner. This quiz does not diagnose medical conditions but rather serves as an indicator for further investigation.

These questions ask about symptoms that you may experience during the 1-2 weeks before your menstrual period starts.

* Indicates a required field

3

I feel much more depressed, down, tearful, sad, or hopeless before the start of my period.* This field is required.

YESNO

4

I feel anxious, tense, nervous, “keyed up” or “on edge” before the start of my period.* This field is required.

YESNO

5

I feel hypersensitive to rejection, or my emotions feel very unstable and unpredictable before the start of my period.* This field is required.

YESNO

6

I feel much more irritable or I get angry easily before the start of my period.* This field is required.

YESNO

7

I have thoughts about suicide or hurting myself before the start of my period.* This field is required.

YESNO

8

I experience feelings of hopelessness before the start of my period.* This field is required.

YESNO

9

I am much less interested than usual in my hobbies and daily activities before the start of my period.* This field is required.

YESNO

10

I find it much harder to concentrate before the start of my period.* This field is required.

YESNO

11

I feel much more tired and low in energy before the start of my period.* This field is required.

YESNO

12

I tend to crave carbohydrates, feel hungry all the time, or eat more than usual before the start of my period.* This field is required.

YESNO

13

I find myself tired, oversleeping or taking naps, or, I’m not sleeping well at night before the start of my period.* This field is required.

YESNO

14

I am bothered by breast tenderness or swelling, increased headaches, joint or muscle pain, bloating or water retention, and/or weight gain before the start of my period.* This field is required.

YESNO

15

These symptoms interfere or cause problems in my day-to-day activities and/or relationships.* This field is required.

YESNO

16

Most of my symptoms disappear by the end of my period.* This field is required.

YESNO

17

I have many of these symptoms the whole month, but they get worse before my period.* This field is required.

YESNO

18

A-list symptoms + B-list symptoms =This field will be hidden (READ ONLY)

19

Does the number of A-list symptoms PLUS the number of B-list symptoms you noted add up to 5 or more?This field will be hidden (READ ONLY)

YESNO

20

Is at least one of the symptoms you noted on the A-list?This field will be hidden (READ ONLY)

YESNO

21

Based on the answers you provided, you may have Premenstrual Dysphoric Disorder (PMDD). We recommend tracking your symptoms for at least two menstrual cycles and sharing with your doctor. Would you like us to email you these results and more information?* This field is required.Please click submit if your answer is NO so your anonymous results can be tallied for research.

YESNO

22

Based on the answers you provided, you may have Premenstrual Exacerbation of an underlying disorder (PME). We recommend tracking your symptoms for a minimum of two menstrual cycles and sharing these results with your doctor. Would you like us to email you these results and more information?* This field is required.Please click submit if your answer is NO so your anonymous results can be tallied for research.

YESNO

23

Based on the answers you provided, you do not meet criteria for PMDD but may have Premenstrual Syndrome (PMS). We recommend tracking your symptoms for a minimum of two menstrual cycles and sharing these results with your doctor. Would you like us to email you these results and more information?* This field is required.Please click submit if your answer is NO so your anonymous results can be tallied for research.

YESNO

24

Based on the answers you provided, you do not appear to have symptoms of PMS, PMDD, or PME.

25

Your information* This field is required.

First Name

Email address

26

Would you like to subscribe to our mailing list to receive a monthly newsletter, tools and resources, and other updates related to PMDD/PME?* This field is required.We won't spam you, and you can unsubscribe at any time!

Yes, subscribe me to the newsletter.

No thanks.

27

Email

example@example.com

28

Screen Results(HIDDEN)

PMS

PMDD

PME

None

29

Screen Results(HIDDEN)