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1. Do you often experience pelvic or lower back pain before or during your period? Only answer “Yes” if this pain limits your day-to-day activities or requires medication.

2. Do you often experience pelvic or lower back pain in between your periods? Only answer “Yes” if this pain limits your day-to-day activities or requires medication.

3. Do you often experience pain with sex?

4. Do you sometimes avoid sex to avoid pain?

5. Do you often have painful bowel movements before or during your period?

If you answered “Yes” to 1 or more of these questions, you could have endometriosis. Even if you answered “No” to all these questions, it is still important to talk to your doctor or healthcare provider about all your symptoms and your medical concerns.

1. Do you often experience pelvic or lower back pain before or during your period? Only answer "Yes" if this pain limits your day-to-day activities or requires medication.   N/A

2. Do you often experience pelvic or lower back pain in between your periods? Only answer "Yes" if this pain limits your day-to-day activities or requires medication.   N/A

3. Do you often experience pain with sex?   N/A

4. Do you sometimes avoid sex to avoid pain?   N/A

5. Do you often have painful bowel movements before or during your period?   N/A

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