Have you ever menstruated?

✅ Yes ❌ No

How old are you?

30

10 20 30 40 50 60 70

Do you have endometriosis in your family?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Do you have endometriosis?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

How much pain in the lower abdomen do you feel during your period?

😊

😐

😕

😟

😖

😭

How much pain in the lower abdomen do you feel when you don't have your period?

😊

😐

😕

😟

😖

😭

Does the pain increase with the years?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Does the pain start a few days before or ends a few days after your period?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Does the pain come in spurts, like daggers?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Does the pain spread to your back?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Does the pain spread to your hips and legs?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Does the pain lead to a disability for daily activities?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Does the pain lead to an inability to stand, walk, or move?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

How much sharp and deep pain do you feel during sexual intercourse?

😊

😐

😕

😟

😖

😭

Are certain sexual positions painful?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Does the pain disrupt, prevent or interrupt sexual intercourse?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

How much pain do you have when you're defecating during your period?

😊

😐

😕

😟

😖

😭

Do you often have spams, cramps, and/or intestinal pain before defecating during your period?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Do you often have diarrhea and/or constipation during your period?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

How much pain do you have when you're urinating during your period?

😊

😐

😕

😟

😖

😭

Do you often have bladder pain when you want to urinate or while holding back during your period?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Do you often have sciatica pain during your period?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Do you often have right shoulder, or right subcostal pain during your period?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

Have you had difficulties conceiving a child for several months or years?

✅ Yes ❌ No 🤏 A little bit 🤷‍♀️ I don't know

SHARE YOUR
DIAGNOSIS

Personal information

Have you ever menstruated?

How old are you?

Do you have endometriosis in your family?

Do you have endometriosis?

Was your endometriosis confirmed by a medical exam?

What type of endometriosis do you have?

Spontaneous pelvic pain

How much pain in the lower abdomen do you feel during your period?

How much pain in the lower abdomen do you feel when you don't have your period?

Does the pain increase with the years?

Does the pain start a few days before or ends a few days after your period?

Does the pain come in spurts, like daggers?

Does the pain spread to your back?

Does the pain spread to your hips and legs?

Does the pain lead to a disability for daily activities?

Does the pain lead to an inability to stand, walk, or move?

Pain during sexual intercourse

How much sharp and deep pain do you feel during sexual intercourse?

Are certain sexual positions painful?

Does the pain disrupt, prevent or interrupt sexual intercourse?

Digestive pain or problems

How much pain do you have when you're defecating during your period?

Do you often have spams, cramps, and/or intestinal pain before defecating during your period?

Do you often have diarrhea and/or constipation during your period?

Other pains

How much pain do you have when you're urinating during your period?

Do you often have bladder pain when you want to urinate or while holding back during your period?

Do you often have sciatica pain during your period?

Do you often have right shoulder, or right subcostal pain during your period?

Have you had difficulties conceiving a child for several months or years?

SHARE YOURDIAGNOSIS

Personal information

Have you ever menstruated?

How old are you?

Do you have endometriosis in your family?

Do you have endometriosis?

Was your endometriosis confirmed by a medical exam?

What type of endometriosis do you have?

Spontaneous pelvic pain

How much pain in the lower abdomen do you feel during your period?

How much pain in the lower abdomen do you feel when you don't have your period?

Does the pain increase with the years?

Does the pain start a few days before or ends a few days after your period?

Does the pain come in spurts, like daggers?

Does the pain spread to your back?

Does the pain spread to your hips and legs?

Does the pain lead to a disability for daily activities?

Does the pain lead to an inability to stand, walk, or move?

Pain during sexual intercourse

How much sharp and deep pain do you feel during sexual intercourse?

Are certain sexual positions painful?

Does the pain disrupt, prevent or interrupt sexual intercourse?

Digestive pain or problems

How much pain do you have when you're defecating during your period?

Do you often have spams, cramps, and/or intestinal pain before defecating during your period?

Do you often have diarrhea and/or constipation during your period?

Other pains

How much pain do you have when you're urinating during your period?

Do you often have bladder pain when you want to urinate or while holding back during your period?

Do you often have sciatica pain during your period?

Do you often have right shoulder, or right subcostal pain during your period?

Have you had difficulties conceiving a child for several months or years?

SHARE YOUR
DIAGNOSIS