Premenstrual and Menstrual Symptoms Rating Scales

Original Editor - Khloud S hreif

Top Contributors - Khloud Shreif  

Introduction[edit | edit source]

Period pain.png

Menstrual symptoms are collection of physical, behavioral, emotional, or psychological symptoms that begin with the the start of the menses (Dysmenorrhea) or few days before the beginning of the period and is called premenstrual syndrome. The severity of symptoms differs from one to another and may interfere with their ADLs. There are no lab investigations or objective methods to assess the severity of symptoms in absence of any other pathology. There are few scales and questionnaires are used either to follow up after an intervention, understand the PMS and Menstrual pain.

WaLIDD score[edit | edit source]

WaLIDD is the abbreviation for Working ability, Location, Intensity, Days of Pain, Dysmenorrhea. It was designed to help with the diagnosis of dysmenorrhea, predict the result of activity limitation, and predict the medical leave.

It is easy to apply, has a smaller delay time in application, and doesn't require a specialist to do[1].

Evidence: for predicting medical leave in university students it showed:

Good LR + 14.2 (95% CI, 13.5–14.9), LR − 0.00 (95% CI, undefined)[2], and high sensitivity[3].

Working ability location Intensity

(Wong-Baker)

Days of pain
0:None 0: None 0: Doesn't hurt 0:0
1: Almost never 1: 1 site 1: Hurts little bit 1: 1-2
2: Almost always 2: 2-3 sites 2: Hurts a little more- even more 2: 2-3
3: Always 3:sites 3: Hurts a whole a lot- worst 3: 3->
1-4 mild dymenorrhea

5-7 moderate dysmenorrhea

7-12 sever dysmenorrhea[4]

Menstrual Distress Questionnaire (MDQ)[edit | edit source]

It is a 46-item self-reporting questionnaire used in assessment, follow-up, and treatment of premenstrual and menstrual symptoms. It detects the type and severity and type of symptoms of different changes even it is physical, , behavioral mood changes, and arousal symptoms during the different phases of the menstrual cycle[5].

There is more than one form for this questionnaire:

  • Form C (Cycle) that enables a woman to report her symptoms during the three phases of her recent menstrual cycle as follows; (4 days before menstrual flow, during menstrual flow, and the remainder of the cycle)
  • Form T (Today) that used to help a woman to describe her experiences on a specific day.

Evidence: This questionnaire is used by researchers and clinicians to help with detecting the effect of therapeutic interventions, however, can not define premenstrual syndrome accuretly[6].

The 47 items were divided into sub-scales: pain, water retention, negative affect, autonomic reaction, concentration, behavior change, and arousal, where she rank her symptoms from 1 ("no experience of the symptom") to 6 ("acute or partially disabling symptoms"). and it is done for the most recent cycle[7].

Pain Concentration Behavioral changes Autonomic reactions Water retention Negative effect Arousl Control
1- Muscle stiffness

2- Headache

3- Cramps

4- Backache

5- Fatigue

6- General aches and pains


1- Insomnia

2-Forgetfulness

3- Confusion

4- Lowered judgment

5- Difficulty concentrating

6- Distractible

7- Accidents

8- Lowered motor coordination

1- Lowered school or work performance

2- Take naps; stay in bed

3- Stay at home

4- Avoid social activities

5- Decreased efficiency

1.Dizziness, faintness

2- Cold sweats

3- Nausea, vomiting

4- Hot flashes



1.Weight gain

2. Skin disorders

3. Painful breasts

4.Swelling




1. Crying

2.Loneliness

3. Anxiety

4.Restlessness

5. Irritability

6. Mood swings

7. Depression

8. Tension



1.Affectionate 2. Orderliness

3. Excitement

4. Feelings of well-being

5. Bursts of energy, activity



  1. Feeling of suffocation
  2. f Chest pains
  3. Ringing in the ears
  4. Heart pounding.
  5. Numbness, tingling
  6. Blind spots, fuzzy vision.

Premenstrual Syndrome Scale (PMSS).[edit | edit source]

It was first developed in 2006, to measure the severity of PMS symptoms, and consists of nine subscales and 44 items (depressive mood, anxiety, fatigue, irritability, depressive thoughts, pain, appetite changes, sleep changes, and swelling), and ranking from 1-5, as 1 = “never,” 2 = “rarely,” 3 = “sometimes,” 4 = “very often,” and 5 = “always”/ extreme changes. The lowest score is 44, and 220 is the highest. If the score (> 132)it will considered a positive PMS, and as the score gets higher then indicate greater severity of symptoms during PMS[8].

Evidence: inter-rater reliability between 0.81 and 0.97. Sensitivity ranges from 83-100%  and specificity range from 64-90%[9].

Premenstrual Symptoms Screening Tool (PSST)[edit | edit source]

Premenstrual Symptoms Screening Tool (PSST) was developed to assist to understand PMS and is used to assess PMDD and PMS severity in adolescents, as it is consists of 19 items divided into 14 premenstrual symptoms, and 5 functional items you can find it here[10]. It is a valid and reliable tool to screen PMS and PMDD[11][12].

References[edit | edit source]

  1. Teherán AA, Piñeros LG, Pulido F, Guatibonza MC. WalIDD score, a new tool to diagnose dysmenorrhea and predict medical leave in university students. International journal of women's health. 2018;10:35
  2. Teherán AA, Piñeros LG, Pulido F, Guatibonza MC. WalIDD score, a new tool to diagnose dysmenorrhea and predict medical leave in university students. International journal of women's health. 2018;10:35.
  3. Rashidi Fakari F, Simbar M, Tahmasebi G, Ebadi A, Rashidi Fakari F, Nasiri M, Ghazanfarpour M. Efficacy of working ability, location, intensity, days of pain, dysmenorrhea (WaLIDD) and Verbal Rating Scale (Pain and Drug) in Diagnosing and Predicting Severity of Dysmenorrhea among Adolescents: A Comparative Study. Journal of Obstetrics, Gynecology and Cancer Research (JOGCR). 2021 Feb 10;6(2):81-6.
  4. Teherán AA, Piñeros LG, Pulido F, Guatibonza MC. WalIDD score, a new tool to diagnose dysmenorrhea and predict medical leave in university students. International journal of women's health. 2018;10:35.
  5. Van Der Ploeg HM. The factor structure of the menstrual distress questionnaire—Dutch. Psychological Reports. 1990 Jun;66(3):707-14.
  6. Hawes E, Oei TP. The menstrual distress questionnaire: Are the critics right?. Current Psychology. 1992 Sep;11(3):264-81.
  7. Ross C, Coleman G, Stojanovska C. Factor structure of the modified Moos Menstrual Distress Questionnaire: assessment of prospectively reported follicular, menstrual and premenstrual symptomatology. Journal of Psychosomatic Obstetrics & Gynecology. 2003 Jan 1;24(3):163-74.
  8. Sut HK, Mestogullari E. Effect of premenstrual syndrome on work-related quality of life in Turkish nurses. Safety and health at work. 2016 Mar 1;7(1):78-82.
  9. Padmavathi MP, Sankar R, Kokilavani N, Dhanapal K, Ashok B. Validity and reliability study of Premenstrual Syndrome Scale (PMSS). International Journal of Advances in Nursing Management. 2014 Jan;2(1):4-10.
  10. Steiner M, Macdougall M, Brown E. The premenstrual symptoms screening tool (PSST) for clinicians. Archives of Women’s Mental Health. 2003 Aug;6(3):203-9.
  11. Câmara RD, Köhler CA, Frey BN, Hyphantis TN, Carvalho AF. Validation of the Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST) and association of PSST scores with health-related quality of life. Brazilian Journal of Psychiatry. 2016 Nov 24;39:140-6.
  12. Hashemi Y, Talepasand S, Alavi K. Psychometric Properties of Premenstrual Symptoms Screening Tool among Female Students of Semnan University. Hayat. 2014 Apr 1;20(2).