With endometriosis, tissue similar to the lining of the womb grows outside the womb. The pain often follows your cycle, but it does not stay inside the days you bleed. An endometriosis symptom diary records two things for that reason: how much it hurts and on which day of your cycle.
Plenty of people treat severe period pain as normal, and some clinicians do too. Tell a doctor "I get bad pain every month" and you may hear that periods hurt. After three cycles of tracking you can say something else: "On five days per cycle my pain was 7 or higher, and on eight days without bleeding I had pain opening my bowels." Your gynaecologist can ask targeted questions about a sentence like that.
The basics, such as the scale, a fixed time for entries and a routine you can keep, are in How to keep a pain diary. Endometriosis adds the cycle as a second axis.
Cycle day as your reference point
Cycle day 1 is the first day of full bleeding. Count forward from there and you can lay months on top of each other: day 2 in March lines up with day 2 in April, even if one cycle lasts 26 days and the next 31. Calendar dates can't give you that comparison.
Say you log an 8 on cycle day 1 in January, a 7 in February and another 8 in March. Taken one at a time, those months look like bad luck. Written in a column, they show you a fixed point in your cycle you can plan around, with a day off or a word with your manager in advance.
After three cycles you will see whether the worst days always fall at the start of bleeding, whether a second peak shows up around mid-cycle, or whether the pain spreads across the whole month. Your doctor reads those as three different pictures.
If you take hormones that stop your bleeding, or your cycle varies a lot, cycle day tells you less. In that case you keep the diary by date and note bleeding and spotting days as they happen.
The contents of each entry
One entry a day is enough as a baseline. On bad days, add a second one in the evening.
| Detail | Example |
|---|---|
| Cycle day | CD 2 |
| Intensity 0 to 10 | 7 |
| Location | Lower abdomen left, lower back |
| Type | cramping, stabbing |
| Bleeding | heavy |
| Other symptoms | pain opening bowels, nausea |
| Impact on your day | left work after two hours |
| What you did | hot water bottle, pain relief as agreed with your doctor |
The "impact" row is the one you are most likely to skip. In the appointment it often counts for more than the number: a day you had to leave work shows your doctor what your 7 means in real life. For words that describe the type of pain, see How to describe pain.
A separate track for symptoms outside your period
Endometriosis can show up beyond period pain. Gynaecologists who suspect it ask about pain during sex, pain opening your bowels or passing urine, and pelvic pain on days without bleeding. Fold all of that into one daily number and you lose the difference between a hard period and a bad day mid-cycle.
Keep those symptoms as separate items, each with a yes or no. For them, frequency matters more than intensity. "Pain opening my bowels on 6 of 28 days, 4 of them during bleeding" gives your doctor something to follow up. A monthly average intensity gives them far less to go on. With the cycle day in every entry, you will also see whether a symptom came in the days before bleeding, during it or around mid-cycle.
Log pain-free days as well. Without them you can't say how many days of a cycle were affected.
Setting this up in PainTrack
PainTrack has no cycle field and no period calendar. You rebuild the cycle link with the tools it has:
- Create a pain called "Pelvic pain" on the 0 to 10 scale and give it the body location Lower abdomen, left and right. If it spreads to your back or groin, change the location in that entry.
- On bleeding days, pick the preset tag "on my period" under "+ Add tags". You choose the pain type there too, for example cramping.
- Start each note with the cycle day, always in the same form: "CD 2".
- When a new treatment begins, add an event such as "Started therapy" under More → Events.
All of that is free, as is the body map over 7 and 30 days. With Pro you add more pains, for example "Pain opening bowels" on the yes/no scale. The trigger analysis then shows whether your values run higher on entries tagged "on my period", and the body map covers 90 days, about three cycles. The PDF doctor's report pulls it together; the sample report shows the layout.
A summary for your appointment
After three cycles, summarise on a single page:
- Days per cycle with pain of 7 or more, and the cycle days they fell on
- Days with pelvic pain and no bleeding
- How often you had pain opening your bowels, passing urine or during sex
- Days you missed work, school or plans
- What you took and how well it helped
Bring the daily entries as backup and put the summary on top. In a short appointment your doctor will get through one page sooner than a stack. For more on preparing, read Preparing for a pain appointment. If you have felt brushed off for a while, When your doctor doesn't believe your pain may help. In the UK, Endometriosis UK offers information and support groups.
Sudden severe pain in your lower abdomen, fever, feeling faint, or pain when you might be pregnant can't wait for the next appointment. Get medical help straight away or call 999 in the UK or 911 in the US.
Frequently asked questions
How long should I keep an endometriosis diary? At least three cycles, so you can tell whether a pattern repeats or a bad month was an outlier.
Which day is cycle day 1? The first day of full bleeding. Note any spotting before it, but don't count it as day 1.
Can a pain diary prove I have endometriosis? No. A doctor makes the diagnosis, for example with an ultrasound or a laparoscopy. Your diary shows when and how often the symptoms appear, which gives your doctor a basis for the next steps.
Should I log days without pain? Yes. With them you can count the affected days per cycle and see whether a treatment changes that number.
PainTrack is not a medical device and does not replace medical diagnosis or treatment. The app is intended for personal documentation and self-observation.