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Endometriosis Appointment Prep Checklist
A one-page visit packet for endometriosis questions, with symptom notes, pain map prompts, period impact, privacy-limited export tips, and questions to bring.
Use this before a gynecology visit. It helps you bring clear notes. It does not diagnose endometriosis.
If pain is severe, new, or unsafe to wait on, contact a clinician now.
One page visit packet
Fill out the short version first. Bring extra logs only if needed.
Topic Your note Main reason for this visit Date symptoms started Last 3 period start dates Worst pain score, 0 to 10 Where pain shows up Bowel symptoms Bladder symptoms What you miss or change because of symptoms Medicines or steps tried Main question for the clinician
Symptom timeline
Use dates if you know them. Estimates are fine.
When What changed? Notes First painful period or pelvic pain First bowel or bladder symptom First missed work, school, sleep, or plans First time pain happened outside your period First exam, scan, or referral Most recent bad flare
Pain map
Mark each place pain shows up. Add when it happens.
Pain area During period Before period Ovulation time Other days Notes Lower belly or pelvis One side of pelvis Lower back Rectum or deep bowel area Bladder area Hips, legs, or thighs Other
Write plain notes. "Sharp rectal pain on day 1" is better than "bad pain."
Bowel and bladder notes
NICE lists period related bowel and urinary symptoms as signs to ask about. Bring simple notes.
Symptom Happens with period? Happens other days? Your note Pain with bowel movements Diarrhea or constipation Bloating Pain when peeing Peeing more often Blood in urine
Period impact
This section shows how symptoms affect daily life.
Area What happened? Work or school Sleep Exercise or errands Child care or family care Social plans Mood or stress
Optional notes
You choose what to share.
Topic Share? Your note Pain during or after sex Yes / no / maybe Fertility goals now Yes / no / maybe Fertility goals later Yes / no / maybe Pregnancy tests or pregnancy history Yes / no / maybe Past trauma or exam concerns Yes / no / maybe
Medicines and steps tried
Do not change medicines because of this sheet. Just list what happened.
What you tried Date or cycle Helped? Side effects or notes Pain medicine Hormone medicine or birth control Heat Rest or position changes Pelvic floor therapy Other
Questions to bring
Could my pattern fit endometriosis? What else could cause these symptoms? What exam or scan fits my case? Would ultrasound help me? What can ultrasound see? What can ultrasound miss? What should we do if imaging is normal? When would referral make sense? What symptoms mean I should call sooner? What should I track before the next visit?
Use the endometriosis ultrasound question list if imaging comes up.
Privacy limited export
Bring the smallest useful record.
Bring Skip unless needed Last 3 to 6 period start dates Full app export Pain score summary Private notes not tied to care Pain map Sex notes if you do not want to share them Bowel and bladder summary Raw screenshots Medicines tried Old data that does not fit this visit
Ask:
What data do you need today? Is a one page summary enough? Will this export go in my medical record? Can I leave out notes that are not needed?
Read period data for endometriosis diagnosis before you share a full export.
Track after the visit
Ask the clinician what to track next. If you are unsure, track the basics.
Track Why it helps Period start dates Shows cycle timing. Pain location Shows where symptoms repeat. Pain score Shows how bad flares get. Bowel and bladder symptoms Shows if symptoms follow your cycle. Missed plans or sleep Shows daily impact. Medicines tried Shows what did or did not help.
Use the endometriosis pain diary, symptom checklist, and bowel and bladder log if you want paper tools. Read period tracking for endometriosis for a fuller tracking plan.