It is difficult to determine the cause of pain as it is different for each individual. Based on tests and medical history, the exact cause may be better determined. Research has shown that endometriotic implants cause a local inflammatory reaction which irritates nerve endings and sends noxious stimuli along the nerve pathways to the spinal cord and into the central nervous system (CNS) where they are interpreted as burning, dull, achy sensations or as sharp, stabbing, or crampy pains. The local inflammatory reaction is mediated by the increased production of substances, such as a variety of cytokines and prostaglandins, originating from the endometriotic implants and cells of the immune system. These substances also stimulate development of scarring and nodules around the endometriotic implants which may compress peripheral nerves compounding pain symptoms with signs of peripheral neuropathy.

Pain symptoms are usually elicited when the nodules are compressed during pelvic examination or sexual intercourse. Endometriotic (chocolate) cysts may compress on other pelvic organs, causing pain and pressure during urination or bowel movements. If there is bleeding from the endometriotic lesions, as it frequently happens during the menstrual period, a woman may notice blood in the urine or stools or in secretions from other organs affected by endometriosis, e.g. blood in the sputum with endometriosis of the lungs. Because of increased systemic cytokine and prostaglandin production by the circulating immune cells, some women with endometriosis may experience generalized symptoms such as low-grade fever; crampy, generalized aches and pains; and nausea, vomiting, and diarrhea usually around the time of the menstrual period. As a first step in helping you control pain associated with endometriosis, please complete the Endometriosis Pain Consultation Form below.

First Name:
Last Name:
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Address 2:
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Your Age:
Your Height:
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Age when pain started:
Location of pain:
Where does it radiate:
How often do you have it:
How intense is the pain:
What makes it worse:
What makes it better:
Specify any current treatment:
Prior treatments:
Do you have endometriosis:
How was it diagnosed:
When was it diagnosed:
How extensive was it:
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Results to date:
# years trying to get pregnant:
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# miscarriages:
How old were you when you first menstruated:
# days usually between periods:
How long do periods last:
Any mid-cycle bleeding:
Date of last menstrual cycle:
Menstrual period pain level:
Do you have regular menstrual cycles:
Heavy or light menstrual flow:
Is Pap Smear within normal limits:
Is mammogram within normal limits:
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past that you have had any of the
following? (check all that apply):		 Abnormal Pap Smear
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