PMS - Strength Or Weakness? - Page 152 Specific Women's Problems Section - Page 145 PMS - Strength Or Weakness? - Page 146 PMS - Strength Or Weakness? - Page 154

Menstrual Symptom Diary Give Us Feedback On This Subject Text Scroll This Chapter Check Out Doctor DeMarco's Recommended Health Products References Prism Calendar, Courtesy of Dr. Robert Reid.

Name:___________________________________
Baseline weight on Day 1:___________ Lbs. or Kg. (circle 1).

Instructions for Completing this Calendar:

  1. On the first day of menstruation prepare the calendar: Considering the first day of bleeding as day 1 of your menstrual cycle enter the corresponding calendar date for each day in the space provided below.
  2. Each Morning: Take weight after emptying bladder and before breakfast. Record Weight Change from baseline.
  3. Each Evening: At about the same time complete the column for that day as described below.
  4. Bleeding: Indicate if you have had bleeding by shading the box above that days date ( ). For spotting use an [x].

Symptoms: If you do not experience any symptoms leave the corresponding square blank. If present indicate severity.

  1. Mild-1: Noticeable but not troublesome.
  2. Moderate-2: Interferes with normal activity.
  3. Severe-3: Temporarily incapacitating.

Lifestyle Impact:

  1. If the listed phrase applies to you that day enter an [x].

Life Events: If you experienced one of these events that day enter an [x].

  1. Experiences: for positive (happy) or negative (sad or disappointing) experiences unrelated to your symptoms specify the nature of the events on the reverse side of this form.
  2. Social Activities: imply events such as a special dinner, show or party etc, involving family or friends.
  3. Vigorous Exercise: implies participation in a sporting event or exercise programme lasting more than 30 minutes.
  4. Medication: In the bottom 3 rows list medications if any and indicate days when taken by entering an [x].

PMS - Strength Or Weakness? - Page 152 Specific Women's Problems Section - Page 145 PMS - Strength Or Weakness? - Page 146 PMS - Strength Or Weakness? - Page 154

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Lose weight  diet and exercise plans
Lose weight diet and exercise plans