Dysmenorrhea (Painful Periods)
How severe are your menstrual cramps?
*
Mild, manageable with no or minimal painkillers
Moderate, sometimes need pain relief
Severe, need strong medication / disrupts daily life
How many days of your period are painful?
*
1–2 days
3–4 days
Almost entire period
Do painful periods affect your work/school/normal activities?
*
Rarely
Sometimes
Often / Always
Pelvic Pain & Usual Symptoms
Do you have pelvic pain outside of your periods?
*
Never
Occasionally
Frequently / daily
Do you experience pain during or after sexual intercourse?
*
Never
Sometimes
Often / Always
How often do you feel chronic fatigue or low energy?
*
Rarely
Sometimes
Almost every day
Have you ever had difficulty conceiving (trying for >1 year without success)?
*
Not applicable / No
Yes, but <1 year
Yes, >1 year
Gastrointestinal Symptoms
Do you experience painful bowel movements during periods?
*
No
Sometimes
Every period
Do you feel bloating, gas, or abdominal swelling around your period?
*
Rarely
Sometimes
Almost every cycle
Do you have diarrhoea or constipation during your periods?
No
Occasionally
Often
Do you notice blood in your stool during periods?
*
Never
Rarely
Frequently
Menstrual Bleeding Patterns
How heavy is your menstrual bleeding?
*
Normal
Heavy (need to change pads/tampons every 2–3 hours)
Very heavy (need to change every 1–2 hours, clots present)
Do you experience spotting before or after your period?
*
No
Sometimes
Often
How long does your period last?
*
3–5 days
6–7 days
More than 7 days
Do your periods come regularly?
*
Yes, every 25–35 days
Sometimes irregular
Frequently irregular / unpredictable
Additional Symptoms
Do you experience pain while urinating during your period?
*
Never
Sometimes
Often
Do you have lower back pain linked with your periods?
*
Rarely
Sometimes
Often / Severe
Do you feel nausea or vomiting during your period?
*
Rarely
Sometimes
Often
Do you feel pelvic or abdominal pain that gets worse over time (not just during periods)?
*
No
Mild / occasional
Persistent / worsening
Do you have family history of endometriosis (mother, sister, aunt)?
*
No
Not sure
Yes
Have you ever been told by a doctor you “might” have endometriosis?
*
No
Unsure / suggested but not confirmed
Yes