Endometriosis Symptom Questionnaire
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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.

1

During your period, do you experience pelvic, abdominal, or lower back pain that limits your activities or requires medication?

2

In between periods, do you experience pelvic, abdominal, or lower back pain that limits your activities or requires medication?

3

Is sexual intercourse painful?

4

Does pain ever cause you to avoid intercourse?

5

Are bowel movements painful before or during your period?

Your responses are anonymous and will be kept confidential.

This questionnaire does not collect personally identifiable information. By clicking to submit your responses, you agree to the terms of use.

Endometriosis Symptom Questionnaire