Monthly Calendar of Endometriosis Symptoms
Grade your symptoms as you experience them each month: Month _____________________, ________
None U Mild Y Moderate Ž Severe
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31 |
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Day
of the week |
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Day
of cycle |
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Menstrual
bleeding |
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Spasmodic/stabbing abdom. cramps/pain |
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Side/flank
pain |
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Low
back pain |
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Pain
in inner thighs |
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Abdominal
tenderness |
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Nausea/vomiting |
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Diarrhea |
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Constipation |
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Bloating |
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Gas |
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Hot
and Cold/Hot Flashes |
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Faintness,
dizziness |
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Fatigue |
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Headaches |
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Pain
during/after intercourse |
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Rectal
pain |
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Rectal
bleeding |
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Suprapubic
pain |
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Urinary
pain |
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Urinary
frequency |
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Tender
Breasts |
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Emotional/Anxious |
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Sciatic
Pain |
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Difficulty
sleeping |
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