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Severe Period Cramp Visit Summary
A visit-prep sheet for unbearable period pain, with pain timing, daily impact, medicine already used, privacy choices, and questions for a clinician.
Severe cramps can be hard to explain after the fact.
Use this sheet to bring clear notes to a visit. It does not name the cause. It does not tell you what medicine to take.
One page summary
Fill this in first.
Field Your notes Main visit question Last period start date Usual cycle length, if known Pain start date and time Pain started before bleeding? yes / no / not sure Worst pain date and time Worst pain location Worst pain score 0 to 10 Pain words crampy / sharp / dull / pressure / burning / stabbing / other How long the worst pain lasted What pain stopped you from doing Medicine or comfort steps already used What you want answered first
OWH says cycle length is counted from the first day of one period to the first day of the next. If cycle day is unclear, use dates.
Pain timeline
Use short notes.
Date Cycle day Bleeding Pain location Pain score What happened : : none / spotting / light / medium / heavy
MedlinePlus says painful periods can include lower belly cramps, back pain, leg pain, nausea, vomiting, loose stools, and headache. Add only the symptoms you choose to share.
Daily impact notes
Mark what changed.
Impact Your notes Missed school, work, or plans Left early or stayed home Could not stand, walk, or sit well Sleep changed Eating or drinking changed Needed help with care tasks Felt scared by the pain Went to urgent care, ER, or clinic
Use plain words:
"Pain made me miss class." "I could not sit through work." "I stayed in bed most of the day." "I used medicine I already had. I want to ask if the label fits me."
Medicine already used
This table is for recordkeeping only. It does not tell you what amount to take.
Product or step When used Label followed? Helped? Side effects or worries yes / no / not sure yes / no / not sure
Bring the bottle, box, photo, or label if you can.
Ask:
Does this product fit my age and health history? Does this label apply to me? Could this interact with my medicine or supplements? Should I ask a pharmacist too? What should I avoid for my case?
Questions to ask
Pick the ones that fit.
What patterns in my notes matter most? What causes should we consider? What contact instructions apply to my notes? Do you need a pain diary before follow up? Should I track pain location? Should I track bleeding amount? Should I track missed school or work? What medicine questions should I ask a pharmacist? What should I bring next time?
For more context, read intense period pain vs endometriosis. Use the period pain diary template if you want a longer log.
Privacy check before sharing
Pain notes can include period dates, school absences, work details, medicine names, clinic names, and private worries.
Before you share, ask:
Who needs this? Would a one page summary work? Can I remove extra cycles? Can I leave out private notes? Will this go into a portal, email, text, download, or backup? Do I want to keep a record of what I sent?
Use the period pain location visit summary if location matters. Read the period pain location data privacy checklist before sharing a full export.
Floriva note
Floriva can help you keep short period pain notes on your device.
Example:
On device notes can reduce some company held copies. They do not control screenshots, exports, backups, portals, messages, or shared devices.