Dysmenorrhea Screening

This survey is to help us understand how menstrual pain (dysmenorrhea) affects you. Menstrual pain is common, but it can vary from person to person. Each question has simple options for you to choose from, and your answers will help us learn more about how dysmenorrhea affects you.

How often does menstrual pain affect your ability to work, study, or perform daily tasks?

None – It doesn’t affect my ability at all.

Almost never – It rarely affects my ability.

Almost always – It frequently affects my ability.

Always – It always affects my ability.

Where do you feel the menstrual pain?

Where do you feel the menstrual pain? None – I do not feel any pain.

1 site – I feel pain in one area (e.g., lower abdomen or back).

2-3 sites – I feel pain in two or three areas (e.g., lower abdomen, back, thighs).

Multiple sites – I feel pain in multiple areas of my body.

How intense is the menstrual pain?

Doesn’t hurt – No pain at all.

Hurts a little bit – Mild pain.

Hurts a little more – Moderate pain.

Hurts a whole lot – Severe pain.

How many days do you experience menstrual pain?

0 days

1-2 days

2-3 days

3 or more days

Your score is

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