Symptoms	Day of menstrual cycle (day 1 is the start of the menstrual period)
	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24	25	26	27	28	29	30	31	32	33	34	35
Felt depressed or sad
Felt hopeless
Felt worthless or guilty
Felt anxious or tense
Had mood swings
Feelings were more easily hurt
Felt angry or irritable
Had conflicts with people
Had less interest in activities
Had trouble concentrating
Felt tired or lacked energy
Had increased appetite
Had food cravings
Slept more or had trouble waking up
Had trouble getting to sleep or staying asleep
Felt overwhelmed
Felt out of control
Had breast tenderness
Had breast swelling or weight gain, or felt bloated
Had headache
Had joint or muscle pain
At least one of the problems noted above caused reduced productivity at work, school, or home
At least one of the problems noted above interfered with hobbies or social activities
At least one of the problems noted above interfered with relationships with others
Menstrual flow: H = heavy, M = medium, L = light or spotting (leave blank for no bleeding)