Clinician handoff
Endometriosis
Designed for a 60-second scan in primary care. Use this to explain why this theory fits, what would weaken it, and which tests are most worth discussing.
Why this still fits
My brain fog tracks closely with my menstrual cycle and pelvic pain. I want to know whether endometriosis could be driving both, and what imaging or specialist assessment is the appropriate next step given current diagnostic guidelines.
What would weaken it
- -No cyclical pain pattern, heavy periods, pelvic symptoms, or inflammation-linked worsening around the fog.
- -The cognitive symptoms don't track with the menstrual cycle, pain load, or anemia risk at all.
- -PMDD, anemia, thyroid disease, or another cause fits the timing better than endometriosis does.
Key points to communicate
- •I want to know whether the fog is coming from endometriosis itself, pain burden, iron loss, hormone shifts, or all of the above.
- •Please separate endometriosis-linked cognitive symptoms from PMDD, menopause transition, thyroid, and anemia.
- •If endometriosis is central, I want to know what parts of the pattern should improve when the disease is better controlled.
- •Could I also have adenomyosis? It co-occurs frequently and affects treatment planning.
- •Are there endometriosis specialist surgeons (excision specialists) in this area? General GYN outcomes differ from specialist outcomes.
Bring this to the visit
- •A cycle map showing when fog is worst relative to menstrual phases.
- •Surgical history: laparoscopy findings, excision or ablation, implant staging.
- •Current medications: hormonal therapy, pain medications, GnRH agonists.
- •A list of symptoms beyond fog: pain severity, fatigue, GI symptoms, bladder issues.
Useful screening structure
- -Cycle-mapped symptom diary (fog + pain + fatigue) for 2-3 cycles.
- -PHQ-9 given high rates of co-occurring depression with endometriosis.
- -Ferritin and iron panel if heavy periods are present.
Tests and measurements to discuss
Endometriosis Evaluation
Assess Comorbidities
Questions to ask directly
- •Is the fog primarily from pain burden, hormonal fluctuations, or systemic inflammation?
- •Would hormonal management that reduces cycling also reduce the cognitive symptoms?
- •Should we check iron and ferritin given my menstrual losses?
- •If excision surgery is planned, can we assess whether fog improves post-operatively?
Functional impact snapshot
- -Rate fog severity at different cycle phases: follicular, ovulation, luteal, menstrual.
- -Track pain medication use against fog - are opioids or NSAIDs contributing?
- -Note whether hormonal treatment (continuous OCP, GnRH) reduces the cyclical fog pattern.
Escalate instead of self-managing if
- •Severe pelvic pain with fever or signs of infection.
- •Bowel or bladder obstruction symptoms if deep infiltrating endometriosis is present.
- •Progressive neurological symptoms unrelated to the cycle that need separate workup.
Peer-reviewed references