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The Endometriosis Coping Zone - Your Initial Endometriosis Appointment: Questions the Doctor May Ask You
THE ENDOMETRIOSIS COPING ZONE
Your initial endometriosis appointment: Questions the
doctor may ask you
By Roberta Speyer, with contributions from Professor Philippe Koninckx, Prim. Univ. Professor Dr. Jörg Keckstein, and Professor Jacques Donnez
 Dansk
version
Versione
Italiana
If you’re like most women with endometriosis, you’ve been concerned about your pelvic pain and other unusual symptoms for quite some time. You may not have been taken seriously at first. Parents, friends, and even doctors may have dismissed your symptoms as a normal part of being female. But deep down, you knew your symptoms weren’t normal. At some point, you decided to listen to that voice inside you. And now you’re going for your initial appointment with the gynaecologist.
To make sure the doctor has all the information he or she needs in order to develop an appropriate treatment plan for you, it’s important to be well-prepared for this first appointment. To help you get ready, we’ve developed a list of questions your doctor may ask you. Think about your answers to the questions ahead of time so you can give the doctor all the information he or she needs to help you.
BASIC QUESTIONS
Most gynaecologists ask several basic questions at every appointment, regardless of the reason you’re there. Record this information in a small notebook and take it with you to each appointment.
|
BASIC QUESTIONS |
YOUR RESPONSES |
| Date
of your first menstrual period: |
|
| Date
of your most recent menstrual period: |
|
| Duration
of your period: |
|
| Type
of flow (heavy, medium, light): |
|
| Do
you have bleeding between periods? |
|
| Do
you menstruate every 28 to 30 days, or are your cycles irregular? |
|
| What
medications, birth control pills, hormones, and/or supplements do you take
on a regular basis?
(Note
the strength and how often these medications are taken.) |
|
| List
any previous illnesses (including sexually-transmitted diseases) and
surgeries you have had:
|
ILLNESS
OR SURGERY |
DATE
|
| List
your immediate family’s major illnesses and diseases:
|
|
| List
all known allergies:
|
|
| Do
you use tobacco? If yes, how much and how often? |
|
| Do
you drink alcohol? If yes, how much and how often? |
|
| Do
you or have you ever used illegal drugs?
If yes, how much and how often? |
|
| Do
you have pain with your menstrual periods?
Try to recognise the pattern of your pain. It’s
important to tell the doctor if you have pain during your menstrual
period, all the time, or if it comes and goes. These questions are often
best answered by keeping a Daily Pain Journal (see
below) that keeps track
of the date, the day in your menstrual cycle, the amount of pain you’re
having, and the duration of the pain (for example, did it last all day or
just part of the day?). |
Yes
No
Sometimes |
| |
|
|
SPECIFIC
PAIN QUESTIONS |
YOUR
RESPONSES |
| Do
you have pain during or after sexual intercourse?
When
talking with your doctor about pain with intercourse, be open and honest
about the type of pain you have, whether it’s with deep penetration or
all the time, whether orgasm makes the pain worse, and what methods
alleviate the pain. |
Yes
No
Sometimes
Pain is worse with deep penetration
I have pain during orgasm
I have pain after orgasm
I have pain with certain sexual positions
|
| Do
you have painful bowel movements?
Many
women with endometriosis report significant bowel pain, including painful
bowel movements, rectal pain, constipation, or diarrhoea. The doctor will
also want to know if you’ve ever experienced blood in your stool and if
any of these symptoms occur during menstruation. |
Yes
No
Sometimes
I have painful bowel movements
I have rectal pain
I have constipation and/or diarrhoea or alternating courses of both
I have had blood in my stool
My bowel symptoms are worse during menstruation |
| Do
you have pelvic pain with physical exercise?
Some women with
endometriosis report feeling more pain when they engage in strenuous
physical exercise. The pain may be more severe during menstruation. |
Yes
No
Sometimes
Pain with exercise is worse during menstruation |
| When
did your pain start? |
Pain started _____ years ago
Pain started recently. When? _______________________ |
| Where
is the pain?
As you answer this question, point to or describe
the area of your body that’s affected.
Some physicians will provide a printed diagram of
the body so you can mark the areas where you have pain. |
|
| Type
of pain?
When
describing pain, consider which adjectives best describe what you
experience. Women often describe endometriosis pain as burning, stabbing,
gnawing, cramping, jabbing, throbbing, cold, sharp, aching, or pressure. |
|
| Severity
of pain?
There are several ways you can describe the pain’s
severity. For example, you may choose to use an adjective, such as
excruciating, severe, moderate, or mild. Or you may choose to use a pain
scale, rating it on a scale of one (no pain) to ten (pain so severe, it
makes you pass out). If
it’s helpful, you may want to refer to the Andrea Mankoski’s Pain
Scale (see below). |
Adjective(s)
that describe my pain:
Pain
on a scale of 1-10: _____
|
| SPECIFIC
PAIN QUESTIONS |
YOUR
RESPONSES |
|
How bad is your pain right now?
Be honest! |
|
| How
many days each month are you in pain?
If you have a really good memory, you may be able to
estimate the number of days you’re in pain each month. However, most of
us tend to put pain out of our minds after it’s come and gone, so our
estimates aren’t always accurate. That’s why a Daily Pain Journal (see
below) is a better way of determining exactly how many days
each month you have pain. |
Number
of days I’m in pain per month: _____ |
| Is the pain
getting worse?
From
the time the pain started until now, has it gotten worse? If so, by what
degree? |
Pain is getting much worse
Pain is getting somewhat worse
Pain is about the same as usual
Pain is getting somewhat better |
| How does the
pain impact your life?
Tell your
physician if you’re missing work or school or declining invitations due
to your symptoms. The doctor will also ask if the pain is preventing you
from engaging in sports or exercise. |
|
| List the
medications you have taken to try to alleviate your pain. Were these
medications effective?
Most
women with endometriosis have tried some type of analgesic or
anti-inflammatory pain reliever. Tell your doctor of any over-the-counter
or prescription medications you have taken or are taking for pain, and
whether they reduce your pain levels.
|
Meds
Taken: |
Effective? |
| List any
alternative methods you are currently using (or have used) to relieve your
pain:
When
traditional methods don’t work, many women incorporate alternative
approaches (such as acupuncture, chiropractic medicine, or biofeedback) to
help alleviate their pain. Tell your doctor if you are taking any herbs or
seeing alternative practitioners for your pain and whether these methods
are effective. |
Method: |
Effective? |
| |
|
| OTHER SYMPTOMS: |
YOUR RESPONSES: |
|
Do you routinely experience nausea with
menstruation? |
Yes
No |
| Do you vomit
during menstruation? |
Yes
No |
| Do
you have unusual vaginal bleeding at any time during your cycle? |
Yes
No |
| Do
you experience painful urination or blood in urine at any time during your
cycle? |
Yes
No |
| Do
you experience bloating during menstruation or at other times? |
Yes
No |
| Do
you have difficulty gaining or losing weight? |
Yes
No |
| Do
you experience fatigue? |
Yes
No |
EXAMPLE
DAILY PAIN JOURNAL
|
DATE
|
DAY
IN CYCLE
|
ACTIVITIES
AND EXERCISE
|
PAIN
LEVEL
(scale
of 1 – 10)
|
TYPE
& LOCATION OF PAIN + OTHER SYMPTOMS
|
HOW
LONG DID PAIN LAST?
|
MEDS
EFFECTIVENESS
|
|
March
15
|
Day
4
|
30
minute morning walk
|
3
|
Cramping
and pressure right below belly button
Diarrhoea
after lunch
|
2
hours
|
Tylenol
(moderately effective)
|
ANDREA
MANKOSKI’S PAIN SCALE
(used
with attribution)
|
0
|
Pain
free.
|
No
medication needed.
|
|
1
|
Very
minor annoyance - occasional minor twinges.
|
No
medication needed.
|
|
2
|
Minor
annoyance - occasional strong twinges.
|
No
medication needed.
|
|
3
|
Annoying
enough to be distracting.
|
Mild
painkillers are effective (i.e., aspirin, ibuprofen).
|
|
4
|
Can
be ignored if you are really involved in your work, but still
distracting.
|
Mild
painkillers relieve pain for 3-4 hours.
|
|
5
|
Can't
be ignored for more than 30 minutes.
|
Mild
painkillers reduce pain for 3-4 hours.
|
|
6
|
Can't
be ignored for any length of time, but you can still go to work and
participate in social activities.
|
Stronger
painkillers (Codeine, Vicodin) reduce pain for 3-4 hours.
|
|
7
|
Makes
it difficult to concentrate, interferes with sleep You can still
function with effort. Stronger painkillers are only partially effective.
|
Strongest
painkillers relieve pain (Oxycontin, Morphine).
|
|
8
|
Physical
activity severely limited. You can read and converse with effort. Nausea
and dizziness set in as factors of pain.
|
Stronger
painkillers are minimally effective. Strongest painkillers reduce pain
for 3-4 hours.
|
|
9
|
Unable
to speak – crying out or moaning uncontrollably – near delirium.
|
Strongest
painkillers are only partially effective.
|
|
10
|
Unconscious.
Pain makes you pass out.
|
Strongest
painkillers are only partially effective.
|
DISCUSSING SYMPTOMS WITH YOUR DOCTOR
Seeing a doctor about pelvic pain and other troubling gynaecological symptoms can be rather uncomfortable. Teens are especially self-conscious in the gynaecologist’s office. However, it is vitally important to carefully explain your symptoms and to be completely honest about everything that’s bothering you. Providing accurate information is the key to evaluating your current condition. By doing so, you’re helping to ensure a correct diagnosis and appropriate treatment.
©2011, Roberta Speyer
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