Endometriosis symptom checklist: what to record before your GP appointment

The average UK diagnosis of endometriosis still takes years. A large part of that delay is language: pain scores are easy to dismiss, and functional impact is not.

In short: Endometriosis symptoms include severe period pain, pelvic pain between periods, pain during or after sex, cyclical bowel and bladder symptoms, profound fatigue and difficulty conceiving. Severity of symptoms does not correlate with the extent of disease.

Pain

• Period pain that stops you working, studying or sleeping
• Pain starting days before bleeding
• Pain that paracetamol and ibuprofen barely touch
• Ongoing pelvic pain between periods
• One-sided pain at ovulation
• Lower back or leg pain that follows a cyclical pattern

Sex

• Deep pain during intercourse
• Pain that continues for hours or into the next day
• Avoidance of sex because of anticipated pain

This is one of the most useful diagnostic clues and one of the least often volunteered. Say it.

Bowel and bladder

• Painful bowel movements, particularly around your period
• Cyclical constipation or diarrhoea
• Bloating that changes across the cycle
• Urinary urgency or pain passing urine
• Blood in urine or stool around your period, which needs prompt review

Fatigue and systemic symptoms

• Exhaustion out of proportion to activity
• Feeling unwell or feverish around your period
• Nausea with pain

Fertility

• Difficulty conceiving after twelve months, or six months over 35
• Sometimes the first sign in women whose pain has always been manageable

How to describe it

Replace "my periods are painful" with impact and frequency:

"I miss one to two days of work every cycle. I take maximum-dose painkillers for four days each month and they do not control it. I have had pain during sex for three years. I have kept a dated record for four months."

That is the version that moves referrals.

Seek urgent advice if

• Pain is sudden and severe
• You have heavy bleeding with dizziness or fainting
• You have blood in urine or stool

Common questions

Can a normal ultrasound rule out endometriosis? No. Superficial disease is frequently invisible on imaging.

Does the pain always come with periods? Not always. Some women have constant pelvic pain, and some have mainly bowel or fertility symptoms.

Can teenagers have endometriosis? Yes. Severe period pain in adolescence should not be dismissed.

Read the full endometriosis guide or find a pelvic health specialist.