Section B: Major Symptoms | ||
Instructions: For each symptom that is present, enter the appropriate number in the Point Score Column. If a symptom is occasional or mild…………….....………score 3 points. If a symptom is frequent and/or moderately severe….....score 6 points. If a symptom is severe and/or disabling….……………...score 9 points. Total the score for this section and record it in the box at the end of this section. | ||
| | Point Score |
1. | Fatigue or lethargy | 3 / 6 / 9 |
2. | Feeling of being "drained" | 3 / 6 / 9 |
3. | Poor memory | 3 / 6 / 9 |
4. | Feeling "spacey" or "unreal" | 3 / 6 / 9 |
5. | Depression | 3 / 6 / 9 |
6. | Numbness, burning or tingling | 3 / 6 / 9 |
7. | Insomnia | 3 / 6 / 9 |
8. | Muscle aches | 3 / 6 / 9 |
9. | Muscle weakness or paralysis | 3 / 6 / 9 |
10. | Joint pain or swelling | 3 / 6 / 9 |
11. | Abdominal pain | 3 / 6 / 9 |
12. | Constipation | 3 / 6 / 9 |
13. | | 3 / 6 / 9 |
14. | Bloating, belching or intestinal gas | 3 / 6 / 9 |
15. | Troublesome vaginal burning, itching or discharge | 3 / 6 / 9 |
16. | Prostatitis | 3 / 6 / 9 |
17. | Impotence | 3 / 6 / 9 |
18. | Loss of sexual desire or feeling | 3 / 6 / 9 |
19. | Endometriosis or infertility | 3 / 6 / 9 |
20. | Cramps and/or other menstrual irregularities | 3 / 6 / 9 |
21. | Premenstrual tension | 3 / 6 / 9 |
22. | Attacks of anxiety or crying | 3 / 6 / 9 |
23. | Cold hands or feet and/or chilliness | 3 / 6 / 9 |
24. | Shaking or irritable when hungry | 3 / 6 / 9 |
| Total Score – Section B | |