keep a track of what's going on
DESCRIPTION
Use this diary to keep a record of all your symptoms.TRANSCRIPT
(mate kirikopu)
+
light
++
medium
+++
heavy
++++clots / flooding
Week Two PAIN
Enter the number of crosses which describe your menstrual flow in the box on the chart.
DAY 1
DAY 2
DAY 3
DAY 4
DAY 5
DAY 6
DAY 7
Rate your pain severity each day and enter the rating score (0 – 10) in the box on the chart.
BLEEDING
U/BM - Pain on Urination/Bowel Movement Tick on the days you experience pain on urination or with bowel movement.
IN BED - Off school or work Tick on the days applicable
0 5 10
No Pain Pain makesyou pass out
DATE STARTED
KEY
PAIN BLEEDING U/BM IN BED SHADE IN WHERE THE PAIN IS
