Might I have Endometriosis? • 3rd Park Hospital

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Endometriosis Treatment Center in Kenya

Might I have Endometriosis? (MIHE tool)

Endometriosis is a disease in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe pain in the pelvis and make it harder to get pregnant.

Page 1 of 8

Do I have severe period pain, needing painkillers? Yes No

Page 2 of 8

Does my pain interfere with my daily activities during the periods? Yes No

Page 3 of 8

Do I get pain while passing stool? Yes No

Page 4 of 8

Do I get pain while passing urine, especially during periods? Yes No

Page 5 of 8

Do my pain symptoms worsen during my periods? Yes No

Page 6 of 8

Do I get pain while having sexual intercourse? Yes No

Page 7 of 8

Do I feel my period pains affect me mentally and psychologically? Yes No

Page 8 of 8

Have I tried for a pregnancy for a year or more and not succeeded? Yes No

Please provide your contact information to proceed.

Your Name

Your Email

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Might I have Endometriosis? (MIHE tool)

Endometriosis is a disease in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe pain in the pelvis and make it harder to get pregnant.

Page 1 of 8

Do I have severe period pain, needing painkillers? Yes No

Page 2 of 8

Does my pain interfere with my daily activities during the periods? Yes No

Page 3 of 8

Do I get pain while passing stool? Yes No

Page 4 of 8

Do I get pain while passing urine, especially during periods? Yes No

Page 5 of 8

Do my pain symptoms worsen during my periods? Yes No

Page 6 of 8

Do I get pain while having sexual intercourse? Yes No

Page 7 of 8

Do I feel my period pains affect me mentally and psychologically? Yes No

Page 8 of 8

Have I tried for a pregnancy for a year or more and not succeeded? Yes No

Please provide your contact information to proceed.

Your Name

Your Email

Please do not fill in this field.