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I rise Mayo Angelou
RP
Your guide to getting the most out of your GP or specialist appointment
Symptom Overview
- How long have you been experiencing symptoms?
☐ Less than 6 months
☐ 6–12 months
☐ Over a year
☐ Several years
- Which of the following symptoms are you currently experiencing?
(Tick all that apply)
☐ Pelvic pain
☐ Painful periods
☐ Pain during or after sex
☐ Painful urination
☐ Painful bowel movements
☐ Bloating or swelling
☐ Fatigue
☐ Difficulty getting pregnant
☐ Nausea
☐ Back pain
☐ Pain during ovulation
Section 2: Menstrual Health
- How would you describe your periods?
☐ Regular
☐ Irregular
☐ Missed periods
☐ Very heavy flow
☐ Very painful
- On a scale of 1 to 10, how painful are your periods?
(1 = mild discomfort, 6 = extreme pain, Don't talk to me pain = 10)
Pain Level: ____ /10
- Do your symptoms worsen at specific times in your cycle?
☐ Yes
☐ No
If yes, when? (e.g., before period, during period, ovulation): _________________________
Section 3: Daily Impact
- How often do your symptoms interfere with daily life?
☐ Rarely
☐ Occasionally
☐ Often
☐ Daily
- In what ways have your symptoms affected the following?
|
Area |
Not at All |
A Little |
A Lot |
|
Work or education |
☐ |
☐ |
☐ |
|
Social life |
☐ |
☐ |
☐ |
|
Physical activity |
☐ |
☐ |
☐ |
|
Mental health |
☐ |
☐ |
☐ |
|
Sleep |
☐ |
☐ |
☐ |
Section 4: Previous Treatments
- Have you tried any of the following to relieve your symptoms?
☐ Painkillers (e.g., paracetamol, ibuprofen)
☐ Hormonal treatments (e.g., contraceptive pill, IUD)
☐ Heat therapy (e.g., hot water bottle)
☐ Diet/lifestyle changes
☐ Surgery (e.g., laparoscopy)
☐ Physiotherapy
☐ Counselling or mental health support
Please list any medications you are currently taking for your symptoms. Please confirm if any of these work:
Section 5: Fertility & Family Planning
- Are you currently trying to get pregnant?
☐ Yes
☐ No
☐ Not currently, but may in future
☐ Not applicable
- Have you experienced any of the following?
☐ Difficulty conceiving
☐ Miscarriage(s)
☐ Pregnancy complications
☐ No fertility concerns
Section 6: Additional Notes or Questions for Your GP
Use this space to write down any questions or concerns you'd like to discuss during your consultation.
This may could include:
- Requesting a referral to a gynaecologist
- Asking about specific scans (e.g., MRI, ultrasound)
- Exploring pain management options
- Requesting a second opinion
Notes/Questions:
Your Checklist Before Your Appointment
✅ Bring this completed questionnaire
✅ Bring your symptom diary (if you have one)
✅ Write down any medications or treatments you're currently using
✅ Bring a trusted friend or request a chaperone if you prefer support
Need Support?
If you’re feeling overwhelmed, or if you feel your symptoms haven’t been taken seriously, you are not alone. We’re here to help.
📧 Contact us: info@relevantpartners.co.uk