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Part of the series: Living with Endometriosis →
11 min readSanoLabs Editorial

Endometriosis: Prepare Your Symptoms for the Doctor

How to describe endometriosis pain to a doctor: when in your cycle, where, how bad, bowel and bladder symptoms, what guidelines say, and when not to wait.

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At a first appointment about possible endometriosis, the doctor starts by asking about your symptoms. It helps to have written down when in your cycle it hurts, where, how badly and what it stopped you doing. You can keep that on paper or in Sam's symptom diary, which rates symptoms such as Pelvic pain as mild, moderate or severe per day and shows symptom days with period days from cycle tracking on one month calendar. There is no evidence that a diary gets you diagnosed faster, but it prepares the conversation.

What will the doctor ask at the first appointment?

In the UK you usually start with your GP. The NHS says the GP will ask about your symptoms and whether close relatives have had endometriosis. They may examine your tummy and pelvis, including an internal vaginal exam, and may take blood tests. Elsewhere the first stop may be a gynecologist (an ob-gyn in the US) or your primary care doctor.

IQWiG, Germany's health information institute, lists what to tell the doctor:

  • Since when you have had the pain.
  • How severe it is.
  • Where in your body it is.
  • What it feels like.
  • When it happens.

How the pain affects daily life matters too, as do the treatments you have tried and how well they worked.

The UK guideline from NICE tells doctors to suspect endometriosis with chronic pelvic pain or with period pain that affects daily life. Deep pain during or after sex counts too, as do bowel or urinary symptoms that come with your cycle. NICE singles out painful bowel movements, pain passing urine and blood in the urine. Doctors should also ask whether a first-degree relative, such as your mother or sister, has endometriosis, because that makes it more likely. The German S2k guideline adds tiredness, menstrual history, past treatments, operations and current medicines, and asks for a structured pain history. The WHO says a careful menstrual history covering pain, heaviness of bleeding and related symptoms can help with the diagnosis. For the rest of the visit, see the doctor appointment checklist for a chronic condition.

How do you describe endometriosis pain clearly?

"I often get tummy pain" is hard to work with. These details make it concrete:

  • When in your cycle: before, during or after your period, between periods, or all the time. The German guideline separates pain that follows the cycle from pain that does not.
  • Where: low in the tummy, one side, lower back, legs. Note if it hurts when you poo, pee or have sex.
  • How bad: always the same scale, such as mild, moderate and severe, or 0 to 10 on paper.
  • What it feels like: cramping, stabbing, dragging, burning.
  • What it costs you: cancelled plans, days off work or school, nights you woke up. The German guideline lists repeated absences as a risk factor for pain becoming chronic.
  • What you took: the name on the pack, how often, and whether it helped.
  • Since when: even if the answer is "since I was a teenager". Up to two thirds of adult women with surgically confirmed endometriosis say their pain began in adolescence, the German guideline reports.

A made-up example line: "Day 1 of my period: low tummy, cramping, severe from midday. Pain when pooing. Left work early. Painkillers twice, barely helped." It is not a benchmark. Pain that comes less often or feels milder is still worth getting checked.

Do not put off the appointment until you have logged "enough". What you have by then is enough to talk about. For what a useful record contains, see Symptom Diary: Paper Template or App?.

Do bowel, bladder and tiredness belong in your notes?

Yes. The WHO says endometriosis can affect bowel movements, urination and sex, and it lists bloating and nausea among the symptoms. When endometriosis involves the bowel, the German guideline describes pain when passing stool, pressure, wind, bloating, diarrhea, constipation or changed bowel habits. In bladder endometriosis, the most common complaints are pain above the pubic bone, needing to pee often and urgently, and pain when peeing.

Many of these symptoms have other causes, and the NHS names irritable bowel syndrome as one look-alike. Endometriosis can also occur alongside other chronic pain conditions, such as irritable bowel or bladder pain syndrome, the German guideline notes. So write everything down, even what does not sound pelvic. Your doctor works out the cause.

Tiredness is part of the guideline history as well. Note which days you were exhausted and whether that lines up with your period. Blood in your stool or urine needs an urgent check by a doctor. That holds even if it only appears around your period.

What do guidelines say about diagnosis, and what does a normal scan mean?

After the conversation comes a pelvic exam. The doctor looks inside the vagina with a speculum and feels for tender areas or lumps, IQWiG explains. NICE recommends offering a transvaginal ultrasound to everyone with suspected endometriosis, even if the exam was normal. The German S2k guideline also names it as the standard first step. An MRI can follow when the ultrasound alone does not show enough.

A normal scan does not rule endometriosis out. NICE says so directly and adds that a referral may still be needed. The European ESHRE guideline makes the same point in a strong recommendation, especially for superficial disease on the lining of the pelvis. NICE says to consider a laparoscopy, a keyhole operation to look inside, even after a normal ultrasound or MRI. The WHO adds that surgery is not always needed before treatment can start.

No blood test confirms endometriosis: the German guideline states that biomarkers are not suitable for diagnosis. If your scan was normal but the pain is not, say so. Your notes show that the symptoms have not gone away.

Why does diagnosis take so long, and does a diary help?

The WHO puts the average time to diagnosis at 4 to 12 years. Germany's Federal Ministry of Health describes delays of more than seven years as common there. According to the WHO, the symptoms are varied and broad, which makes them hard to place. In many countries, it says, most people are not aware that the chronic pelvic pain of endometriosis is not normal. That includes most health workers. IQWiG adds that many people wrongly see even very bad pain as a normal part of their period.

Nobody has shown that a diary shortens that wait. The ESHRE guideline finds no evidence that a symptom diary, questionnaire or app reduces the time to diagnosis. It does see a possible benefit alongside the usual history taking: a diary makes pain more concrete and helps you show your symptoms. NICE tells doctors to let people know that a pain and symptom diary can aid discussions. That is its job: preparation, not a shortcut.

If you feel brushed off, When your doctor does not take your symptoms seriously covers how to prepare.

What does Sam keep, and what stays on paper?

Sam's symptom diary has ready-made entries for Pelvic pain, Abdominal pain, Abdominal cramps, Lower back pain, Painful urination, Bloating, Diarrhea, Constipation, Nausea and Fatigue. Each symptom gets one entry per day: mild, moderate or severe. Sleep changes, Blood in stool and Blood in urine are logged as present. Period pain and painful bowel movements have no ready-made entry. You add them under "Other" as your own symptoms, in your own words.

Bleeding goes into cycle tracking, with the flow from Spotting to Heavy. Under "How it went" you can add options such as "Changed my plans" or "Woke me at night". In Health History, symptom days and period days appear as dots on the same month calendar. If your sex is set to Male in Settings, Sam hides cycle tracking.

The Cycle report counts your cycles and the days of bleeding between periods, gives cycle length and bleeding days per period, and lists your 30 most recent entries. You create the monthly report yourself, from the 1st of a month for the previous month. It shows symptom days on a calendar and your five most logged symptoms, but no period days and no medicines. It needs notifications allowed, Apple Health access and a chronic condition entry. From the second report on, it also needs at least 15 logged days out of the last 30. That means how you felt: Good, A bit off or Sick. Symptom entries do not count toward that.

Painkillers you take as needed go into your medication list. You tick them off on today's symptom sheet under "Took something?". There is no reminder for them. The catalog is a selection, not a recommendation, so check the strength on your pack.

Paper also keeps times of day, a 0 to 10 scale, what the pain feels like and whether a dose helped. Neither the symptom diary nor cycle tracking has a free-text note field. Sam does not place symptoms on cycle days and cannot tell you whether your pain is endometriosis. What else Sam keeps for this condition is on the endometriosis page.

When should you not wait for your appointment?

Call your local emergency number (112 in the EU, 999 in the UK, 911 in the US) for pelvic pain that is severe or comes on suddenly and intensely. The same applies if it is getting worse or hurts when you move or touch the area, or if it comes with:

  • Feeling faint, dizzy or lightheaded, or passing out.
  • Pain in the tip of your shoulder.
  • Difficulty breathing.
  • Heavy bleeding from the vagina.
  • Sudden confusion.
  • A high temperature, or feeling hot, cold or shivery.

Severe difficulty breathing, sudden chest pain that does not go away, or chest pain with shortness of breath, sweating, feeling sick or light-headed also needs an emergency call, including around your period. The NHS notes that endometriosis is sometimes found in the chest. Do not wait for it to pass. Call your local emergency number too if you cough up more than a few spots or streaks of blood, or if you cough up blood and find it hard to breathe, have a very fast heartbeat or have pain in your chest or upper back. A few small spots or streaks of blood, or blood in your phlegm or handkerchief, need urgent help.

Get urgent help for period or pelvic pain that is severe or worse than usual. This applies all the more if painkillers have not helped. The same goes for pelvic pain with:

  • Blood in your pee or poo.
  • Trouble peeing or pooing.
  • Pain when peeing, or needing to pee more than usual.
  • Unusual discharge or bleeding from the vagina.
  • Vomiting and diarrhoea, or feeling sick.
  • A pregnancy or possible pregnancy.

In the UK, that means an urgent GP appointment or NHS 111. Elsewhere, ask your doctor's office for an urgent appointment or use an out-of-hours service. These lists come from different sources and overlap. If in doubt, go with the more urgent option.

Book a regular appointment if:

  • You think you might have endometriosis.
  • You have pelvic pain that comes and goes or does not go away.
  • Period pain stops you doing your usual daily activities.
  • Your symptoms affect everyday life, work or relationships.
  • Your periods become more painful, heavier or irregular.
  • Sex, peeing or pooing hurts.
  • You bleed between periods.
  • You change a pad or tampon every 1 to 2 hours, or bleed through your clothes.
  • You notice a change in how much you pee or poo, or your tummy is swollen.
  • Bloating, diarrhoea or constipation does not go away.
  • You are losing weight without trying, feel full quickly or have no appetite.
  • Treatment has not helped.

If none of these fits but you are worried, you can still have your symptoms checked at any time. If symptoms get worse, do not wait for that appointment. Sam replaces neither an emergency call nor an examination.

Log pain days and bleeding in Sam and bring them to the visit

You walk in with counted pain days and bleeding days instead of "basically every month".

  • Instead of a note in your bag: you rate Pelvic pain, Abdominal pain, Bloating or Painful urination per day in the symptom diary, and add period pain as your own symptom.
  • Instead of two separate lists: period days from cycle tracking and symptom days sit on one month calendar in Health History.
  • Instead of counting back in the waiting room: you bring the Cycle report as a PDF and create the monthly report with symptom days and top symptoms yourself.

Sam keeps no times of day, 0 to 10 pain scale or free-text notes here, so paper stays useful. More on the endometriosis page.

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Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Sources

Updated: October 2026

More on Endometriosis

Frequently Asked Questions

How do I describe endometriosis pain to my doctor?+

Be specific: since when you have had the pain, when in your cycle it comes, where you feel it, how bad it is, what it feels like and what it stopped you doing. IQWiG, Germany's health information institute, lists these points for the first conversation. Add what you have already taken or tried and how well it worked.

What should I write down before my first appointment?+

Besides period pain and pelvic pain, the NICE guideline lists deep pain during or after sex and bowel or urinary symptoms that come with your period, in particular painful bowel movements, pain passing urine and blood in the urine. Note how heavy your bleeding is, tiredness, past treatments and operations, the medicines you take now, and whether a mother or sister has endometriosis.

Can an ultrasound rule out endometriosis?+

No. NICE recommends a transvaginal ultrasound for everyone with suspected endometriosis, but says a normal exam and scan do not exclude it and that a referral may still be needed. The European ESHRE guideline makes the same point in a strong recommendation, especially for superficial disease on the lining of the pelvis.

Is there a blood test for endometriosis?+

No. The German S2k guideline states that biomarkers are not suitable for diagnosing endometriosis. The NHS says a GP may still do blood tests, but the starting point is the conversation about your symptoms, a pelvic exam and an ultrasound.

Why does an endometriosis diagnosis take so long?+

The WHO puts the average time to diagnosis at 4 to 12 years. It describes symptoms that are varied and broad, so they are not easy to place, and says that many people do not know the chronic pelvic pain of endometriosis is not normal. IQWiG adds that many people wrongly see even very bad pain as a normal part of their period.

Will a pain diary get me diagnosed faster?+

There is no evidence for that. The ESHRE guideline says nothing so far shows that a symptom diary, questionnaire or app shortens the time to diagnosis, though it sees a possible benefit alongside the usual history taking. NICE says a pain and symptom diary can help the conversation with your doctor. That is what it is for.

When is pelvic pain an emergency?+

Call your local emergency number (112 in the EU, 999 in the UK, 911 in the US) if pelvic pain is severe or comes on suddenly and intensely, is getting worse or hurts when you move or touch the area, or if it comes with feeling faint, dizzy or passing out, pain in the tip of your shoulder, difficulty breathing, heavy bleeding from the vagina, sudden confusion, or a high temperature or feeling hot, cold or shivery. Severe difficulty breathing, sudden chest pain that does not go away, or chest pain with shortness of breath, sweating, feeling sick or light-headed also needs an emergency call, including around your period. Coughing up more than a few spots or streaks of blood, or coughing up blood with difficulty breathing, a very fast heartbeat or pain in your chest or upper back, needs an emergency call too; a few small spots or streaks of blood, or blood in your phlegm, need urgent help. Get urgent help (in the UK, an urgent GP appointment or NHS 111; elsewhere, an urgent appointment or your out-of-hours service) for period or pelvic pain that is severe or worse than usual, especially when painkillers have not helped, and for pelvic pain with blood in your pee or poo, trouble peeing or pooing, pain when peeing or needing to pee more than usual, unusual discharge or bleeding from the vagina, vomiting and diarrhoea or feeling sick, or if you are or may be pregnant. If in doubt, go with the more urgent option.

Can I keep this record in Sam?+

Partly. In the symptom diary you rate Pelvic pain, Abdominal pain or Painful urination as mild, moderate or severe per day, and add period pain or painful bowel movements as your own symptoms. Bleeding goes into cycle tracking. There is no time of day, no 0 to 10 scale and no free-text note, so those stay on paper.

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