Table 2.
Over the last week, how often have you been bothered by the following problems? | Not at all | Several days | More than half the days | Nearly every day |
---|---|---|---|---|
Headache | □ | □ | □ | □ |
Dizziness | □ | □ | □ | □ |
Muscle aches | □ | □ | □ | □ |
Skin rash | □ | □ | □ | □ |
Cold sore | □ | □ | □ | □ |
Coughing | □ | □ | □ | □ |
Sneezing | □ | □ | □ | □ |
Runny nose | □ | □ | □ | □ |
Fever/chills | □ | □ | □ | □ |
Painful urination | □ | □ | □ | □ |
Vaginal irritation/itching | □ | □ | □ | □ |
Backache | □ | □ | □ | □ |
Abdominal cramps | □ | □ | □ | □ |
Physical fatigue | □ | □ | □ | □ |
Abdominal bloating | □ | □ | □ | □ |
Breast tenderness/soreness | □ | □ | □ | □ |
Acne flare-up | □ | □ | □ | □ |
Constipation | □ | □ | □ | □ |
Diarrhea | □ | □ | □ | □ |
Fluid retention (“water weight”) | □ | □ | □ | □ |
Nausea | □ | □ | □ | □ |
Joint pain | □ | □ | □ | □ |