Endometriosis Symptom Self-Check

Take our short Endometriosis Symptoms Questionnaire to better understand your symptoms.

I have read the Personal Data Protection Notice provided by SunMed Velocity Sdn Bhd pursuant to Section 7 of the Personal Data Protection Act 2010, which includes purposes for which my personal data and sensitive personal data are collected / processed and classes of third parties to whom SunMed Velocity Sdn Bhd will / may disclose my personal data and sensitive personal data to.

I verify that the personal information provided in this form is accurate and up-to-date. If completing this form on behalf of others, I confirm I have their consent or the legal right to share their information with the Hospital.

I acknowledged that this questionnaire is intended for informational and educational purposes only. The results of this questionnaire are not a substitute for professional medical advice, diagnosis, or treatment. This questionnaire is designed to help you identify potential symptoms of endometriosis and encourage you to seek further evaluation from a qualified healthcare provider.

Personal Information

Questionnaire

1. Pain Assessment

On a scale of 0 to 10, how would you rate the severity of your menstrual cramps (0 being no pain and 10 being the most intense pain you can imagine)?

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • No Pain
  • Hurts a lot
  • Very severe








2. Menstrual Health









3. Fatigue



4. Fertility Concerns



5. Symptom Impact on Daily Life





Next

RESULT

You have answered “” questions with "Yes" which may indicate symptoms of endometriosis.

We recommend scheduling an appointment with one of our Consultant Gynaecologists. Early consultation can help manage symptoms and improve quality of life.

or

Disclaimer: This questionnaire is intended for informational and educational purposes only. The results of this questionnaire are not a substitute for professional medical advice, diagnosis, or treatment. This questionnaire is designed to help you identify potential symptoms of endometriosis and encourage you to seek further evaluation from a qualified healthcare provider.

It appears you may not have symptoms commonly associated with endometriosis.

If you have any questions regarding endometriosis, please book an appointment with our consultant gynaecologist.

or

Disclaimer: This questionnaire is intended for informational and educational purposes only. The results of this questionnaire are not a substitute for professional medical advice, diagnosis, or treatment. This questionnaire is designed to help you identify potential symptoms of endometriosis and encourage you to seek further evaluation from a qualified healthcare provider.

Although you have not reported symptoms commonly associated with endometriosis, your pain score suggests moderate to severe discomfort.

We recommend consulting a gynaecologist to explore other potential causes of your pain and to ensure appropriate care and treatment.

or

Disclaimer: This questionnaire is intended for informational and educational purposes only. The results of this questionnaire are not a substitute for professional medical advice, diagnosis, or treatment. This questionnaire is designed to help you identify potential symptoms of endometriosis and encourage you to seek further evaluation from a qualified healthcare provider.