PMDD Screening Questionnaire

Premenstrual Dysphoric Disorder (PMDD)

Self-Report Screening Questionnaire

About PMDD

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome that affects 3–8% of menstruating women. Unlike typical PMS, PMDD causes severe mood symptoms including depression, anxiety, irritability, and mood swings that occur in the week or two before menstruation and significantly interfere with daily life, relationships, and work. Symptoms typically improve within a few days after menstruation begins.

About This Questionnaire

This self-report screening questionnaire is designed to help identify whether your symptoms may be consistent with PMDD or PMS. It assesses the severity of emotional, behavioural, and physical symptoms, as well as their timing in relation to your menstrual cycle and their impact on your daily functioning.

Important: This is a screening tool only and cannot diagnose PMDD. A formal diagnosis requires prospective daily symptom tracking over at least two menstrual cycles by a qualified healthcare professional.

Instructions for Completion

  • Answer honestly based on your experiences over the past few menstrual cycles
  • Consider timing – focus on symptoms that occur in the week or two before your period
  • Rate severity according to how much each symptom affects you
  • Complete all sections for the most accurate screening results
  • Allow 10–15 minutes to complete the questionnaire

🔒 Privacy Notice

Your results are completely private and are NOT stored or transmitted anywhere. All processing happens locally in your browser.

Important: Because your results are not saved, you must either:

  • Print your results using your browser's print function, or
  • Screenshot or photograph your results, or
  • Write down your key scores

We recommend bringing your results to discuss with your healthcare provider.

⚠️ Important Information

This is a screening tool, not a diagnostic instrument. Only a qualified healthcare provider can make a formal diagnosis using prospective daily symptom tracking over at least two consecutive menstrual cycles.

If you are experiencing thoughts of self-harm or suicide, please seek immediate help:

  • Emergency Services: 000
  • Lifeline: 13 11 14 (24-hour crisis support)
  • Beyond Blue: 1300 22 4636

Section 1: Demographic Information

Section 2: Symptom Assessment

Instructions: Think about your experiences during the week before your period starts over the past three menstrual cycles. Rate how severe each symptom typically is during the premenstrual week.

Rating Scale:

1 = Not at all (I do not experience this symptom)
2 = Minimal (Very mild, barely noticeable)
3 = Mild (Noticeable but not bothersome)
4 = Moderate (Bothersome and causes some difficulty)
5 = Severe (Causes significant difficulty and distress)
6 = Extreme (Overwhelming and causes major problems)

Core Emotional and Mood Symptoms

Behavioural and Cognitive Symptoms

Appetite and Sleep Symptoms

Physical Symptoms

Section 3: Functional Impairment Assessment

Instructions: Consider how the premenstrual symptoms you experience affect your daily life during the week before your period. Rate the level of interference using the same 1-6 scale.

Section 4: Timing and Pattern Questions

Section 5: Differential Diagnosis Screening

Your Screening Results

Total Score

0
Range: 20-120

Symptom Score

0
Range: 16-96

Impairment Score

0
Range: 4-24

Moderate-Severe Symptoms

0
Core: 0

📋 Important Next Steps

  • This is a screening tool only - A healthcare provider must confirm diagnosis using prospective daily symptom tracking for at least 2 menstrual cycles.
  • Save or print these results to discuss with your doctor at your next appointment.
  • Begin daily symptom tracking using a validated tool like the Daily Record of Severity of Problems (DRSP).
  • Learn about PMDD at the International Association for Premenstrual Disorders (iapmd.org).