Endometriosis Symptom Questionnaire

Please tick to complete the questionnaire below to screen for endometriosis symptoms.

1 During your period, do you experience pelvic, abdominal, or lower back pain that limits your activities or requires medication?
Please select
2 In between periods, do you experience pelvic, abdominal, or lower back pain that limits your activities or requires medication?
Please select
3 Is sexual intercourse painful?
Please select
4 Does pain ever cause you to avoid intercourse?
Please select
5 Are bowel movements painful before or during your period?
Please select

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