Pain Characteristics in
Endometriosis at Different Stages Survey

Dear potential participant

We are medical students conducting a research study to explore the pain
characteristics in endometriosis at different stages.
Your participation in this study would greatly contribute to our understanding of
endometriosis and its impact on pain symptoms. We would like to emphasize
that your involvement is entirely voluntary, and you have the freedom to decide
whether you would like to participate. We also want to assure you that if you come
across any questions or concepts that you do not understand during the research,
you can contact us at any point in the process, and we will provide clarification and
assistance to the best of our ability.

Your contribution to this study would be highly valuable, and we appreciate your consideration.

The survey is entirely anonymous.
Thank you for your time and potential participation.
Mail for contact - lanaoren1992@gmail.com

General

Age (years old)











Have you started experiencing menopause?



Endometriosis

Have you been diagnosed with endometriosis?



Stage of Endometriosis (rASRM)










On average, how intense is the pain during and/or after sexual intercourse



On average, how intense is the pain during defection




On average, how intense is the pain during urination




If you have any other gynecological conditions, please mention so here (if not, write "None")




If you have any other chronic diseases, please mention so here (if not, write "None")


Menstrual Cycle

Age of Menarche (first menstruation)






Average menstrual cycle (before starting Birth control/IUD)








On average, how long is your period? (before starting Birth control/IUD)







Areas you feel the cyclic pain (pain beofre menstruation and/or during menstruation)








On average, how intense is the cyclic pain (pain beofre menstruation and/or during menstruation)



Do oral painkillers help?


Pain Characteristics

Click on the areas you experianced chronic pain in the 1 last year, then scroll down and answer the questions.
No limit to how many areas you can choose.
(Chronic pain = pain that is constant or recurrent for more than 3 months)
If you don't have chronic pain, choose a random area and answer "0" and "Do not take painkillers for it"

Description of the image Area 1 Area 2 Area 3 Area 4 Area 6 Area 5 Area 7 Area 8 Area 9 Area 10 Area 11 Area 12 Area 13 Area 14a Area 14b Area 15 Area 16 Area 17 Area 18 Area 19 Area 20 Area 21 Area 22 Area 23 Area 24 Area 25 Area 26 Area 27 Area 28 Area 29 Area 30 Area 31 Area 32 Area 33 Area 34 Area 35a Area 35b Area 36 Area 37 Area 38 Area 39 Area 40 Area 41 Area 42

Lifestyle

Do you drink coffee once a day



Do you smoke cigarettes everyday



Do you drink strong alchool every week



Do you exercise 1-3 a week



If yes, what is the exercise intensity
(if you answered "No" in previous question, choose "None")





What other medications do you take? (if not, write "None")




If there is anything else you think we should know, please write here
(if not, write "No")