Short answer

Each day, rate your pain from 0 to 10, note where it is and what it feels like, and mark your period days. Add pain during or after sex, painful bowel movements or urination, bloating, fatigue and any medicine you took. A dated diary shows how pain lines up with your cycle and gives your doctor clear evidence.

Key facts

  • Endometriosis affects an estimated 10% (190 million) of reproductive-age women worldwide.[1]
  • UK NICE guidance tells doctors to let women with suspected or confirmed endometriosis know that a pain and symptom diary can aid discussions.[2]
  • Diagnosis can involve imaging such as ultrasound, and sometimes surgery.[1]

What should you log each day?

What to logHow
Pain score0 (no pain) to 10 (worst pain you can imagine), at about the same time each day
Where it hurtsPelvis, lower back, belly, legs or elsewhere
What it feels likeCramping, stabbing, burning or aching, and what you were doing
Period days and flowSo pain can be matched to your cycle
Sex, bowel and bladderPain during or after sex, painful bowel movements, pain passing urine or blood in your urine
Other symptomsBloating, nausea, fatigue and heavy bleeding
MedicinesName, dose, time and how much it helped
ImpactMissed work or school, or plans you had to cancel

Which symptoms make doctors suspect endometriosis?

NICE advises doctors to suspect endometriosis in women, including those aged 17 and under, who have one or more of these:[2]

  • Chronic pelvic pain
  • Period-related pain that affects daily activities and quality of life
  • Deep pain during or after sex
  • Period-related or cyclical bowel symptoms, especially painful bowel movements
  • Period-related or cyclical urinary symptoms, especially blood in the urine or pain passing urine
  • Infertility together with one or more of the above

WHO also lists heavy menstrual bleeding, abdominal bloating and nausea among the symptoms, and notes that long delays in diagnosis are common.[1]

How do you use a pain diary at an appointment?

  1. Bring entries covering a few cycles if you can.
  2. Point out the pattern: which cycle days pain peaks, and what helped.
  3. Explain how pain affects work, school, sleep and relationships.
  4. Ask what the next steps are, such as an examination, an ultrasound or a referral.

When should you get urgent help?

Get urgent medical care for sudden, severe pain, or pain that comes with fever, fainting or very heavy bleeding. Bleeding that soaks through one or more pads or tampons every hour for several hours in a row also needs medical attention.[3]