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11

Are there cyclical headaches (related to the menstrual cycle)?

Yes No

10

Increased breast sensitivity during the premenstrual period?

Yes No

9

Irregular menstrual cycle tends to shorten?

Yes No

8

Painful or very heavy menstruation, is there a need for pain relief medication?

Yes No

7

Are there bloating, and is there fluid retention in the body (weight increases by 1-3 kg before menstruation)?

Yes No

6

Are there cysts in the ovaries, in the breast, or endometriosis?

Yes No

5

Restless, shallow sleep, having trouble falling asleep?

Yes No

4

Do you experience irritability, anxiety, aggressiveness, especially before menstruation?

Yes No

3

Do you feel muscle tension and can't relax?

Yes No

2

Do you have a low pain threshold?

Yes No

1

Was there a miscarriage or a threat in the first trimester of pregnancy?

Yes No