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Managing Premenstrual Symptoms

(Published June 2008)

Appendix B

Patient Screening Test for Premenstrual Dysphoric Disorder1

FIRST: Check all the symptoms from both the A-List and the B-List that you have on a daily basis during the week before your period starts:

A-LIST SYMPTOMS (during the week leading up to my period)

___ I feel much more depressed and down in my mood.

___ I feel anxious, tense, keyed up, or on edge.

___ I feel hypersensitive (to rejection or criticism) or I feel very unstable and unpredictable in my emotions.

___ I feel much more irritable or I get angry easily.

Number of A-List symptoms I checked: ____

B-LIST SYMPTOMS (during the week leading up to my period)

___ I am much less interested than usual in my hobbies and daily activities.

___ I find it much harder to concentrate on things.

___ I feel much more tired and low in energy.

___ I have a tendency to crave carbohydrates or go on eating binges.

___ I find myself oversleeping or taking naps, or I’m not sleeping well at night.

___ I feel or have felt very overwhelmed or out of control.

___ I am very bothered by at least two of the following physical symptoms:

___ Breast tenderness or swelling

___ Increased headaches

___ Joint or muscle pain

___ Feeling “bloated”

___ Weight gain

Number of B-List symptoms I checked: ____

SECOND: Answer these 4 questions (circle the correct answer):

1. Does the number of A-List symptoms PLUS the number of B-List symptoms add up to 5 or more?

___ YES ___ NO

2. Is at least one of the symptoms you checked on the A-List?

___ YES ___ NO

3. Do most if the symptoms you checked disappear within 3 days of the start of your period?

___ YES ___ NO

4. When you are having these symptoms, do they interfere with your ability to function normally and perform your daily activities?

___ YES ___ NO

If the answer to ALL four questions is YES, then you may have PMDD. Speak with your clinician about the next step to get help with your symptoms.


  1. Freeman EW, Sondheimer SJ. Premenstrual dysphoric disorder: recognition and treatment. Primary Care Companion J Clin Psychiatry. 2003;5:30–39.