Endometriosis Symptom Questionnaire
Please tick to complete the questionnaire below to screen for endometriosis symptoms.
Pelvic pain can be a symptom of endometriosis, which occurs when tissue that lines a woman’s uterus during the menstrual cycle grows outside of the uterus, such as the surface of the uterus, lining of the abdomen, lining of pelvic cavity, ovaries, fallopian tubes, cervix and bladder wall. Often women or their healthcare providers may mistake this pain for the expected discomfort of menstruation. But once diagnosed, endometriosis is treatable. Gynecologists at Women’s Health Center, Bangkok Hospital are experts in diagnosing this condition and developing the treatment that best fits treatment goals and your lifestyle.
Detail
1
During your period, do you experience pelvic, abdominal, or lower back pain that limits your activities or requires medication?
Always
Sometimes
Never
2
In between periods, do you experience pelvic, abdominal, or lower back pain that limits your activities or requires medication?
Always
Sometimes
Never
3
Is sexual intercourse painful?
Always
Sometimes
Never
4
Does pain ever cause you to avoid intercourse?
Always
Sometimes
Never
5
Are bowel movements painful before or during your period?
Always
Sometimes
Never