Your pain is real. Your patterns matter. Your care should match. The Endometriosis Violet Sheet helps Black women track symptoms throughout the full cycle, document the daily impact, and advocate for evaluation and relief using the ROOT Framework: Reveal, Offer, Outline, Take Note.

• Built for OB-GYN, primary care, urgent care, and specialist visits
• Clear checklists, prompts, and scripts you can use word-for-word
• Designed to help you leave with a plan, not vague reassurance

Why this Violet Sheet Matters

Endometriosis is often misunderstood and under-recognized, and many people are told their pain is normal cramps or just stress. This tool helps you show the full picture: when the pain happens, how severe it is, what triggers it, and what it costs you in real life.

Use it to document:

• Pelvic pain and cramping that limit activity
• Pain before, during, or after your period
• Pain with sex, bowel movements, or urination
• Heavy bleeding, clots, or spotting between periods
• Bloating, fatigue, nausea, and migraines around your cycle
• Fertility concerns or a history of normal imaging with ongoing symptoms

What You’ll Get (inside the Endometriosis Violet Sheet)

• ROOT Framework pages (Reveal, Offer, Outline, Take Note)
• Symptom and pattern checklists to capture what happens across your cycle
• Prompts that translate pain into documentation (severity, triggers, and functional impact)
• Questions to request a step-by-step plan (including what to do if imaging is normal)
• Advocacy scripts for rushed visits, unclear answers, or dismissal
• Fillable PDF layout you can save, type into, and bring to your appointment

How to Use It

1. Track across your cycle for at least 2 weeks (longer is even better).
2. Bring it to your visit and use the scripts to clearly name your concern.
3. Ask for a plan that includes relief now, evaluation steps, and a timeline.
4. Write down the next steps (tests, referrals, follow-up date) before you leave.

Who It’s For

• Black women with painful periods or pelvic pain that disrupts their lives
• Anyone with pain that returns every cycle or shows up with sex, bowel movements, or urination
• People who have been dismissed, told it’s normal, or left without next steps
• Anyone seeking a clear plan for evaluation, symptom relief, and follow-up

What This Is (and What It Isn’t)

• This is a self-advocacy tool to support clearer communication and better follow-through.
• It is not medical advice, diagnosis, or treatment.

Call to action

Complete and download the Endometriosis and Pelvic Care Violet Sheet and walk into your next appointment prepared, documented, and supported.

Please enable JavaScript in your browser to complete this form.

– Step 1 of 6

Purpose & Instructions

Use this sheet to track pelvic pain, bleeding changes, and daily-life impact so you can advocate for thorough evaluation and a clear plan for suspected or diagnosed endometriosis. Bring it to your OB-GYN, primary care visit, urgent care, or specialist consult.

Date

NextSave and Resume Later

Section 1: Reveal -What's Going On

Instructions: Check all symptoms or changes you’ve noticed. Add any details you want to share.

Focus: Self-Awareness & Pattern Recognition

• Track pelvic pain and period symptoms across your full cycle (not only on bleeding days).
• Notice patterns: before period, during period, ovulation, after sex, bowel movements, urination, exercise, stress, or long-standing.
• Track what you miss because of symptoms (work, school, caregiving, sleep, intimacy).
• Note history that can raise concern: painful periods since teen years, infertility, ovarian cysts, fibroids, prior “normal” ultrasounds, family history.

Empowerment Goal: Recognize that severe pain is not “normal,” and you deserve answers, options, and relief.

Your Checklist

• Pelvic pain/cramping that limits activity
• Pain that starts before bleeding
• Pain that continues after period ends
• Pain with ovulation/mid-cycle
• Low back pain
• Hip/groin pain
• Leg pain/sciatica-like pain
• Heavy bleeding
• Clots
• Spotting between periods
• Bleeding longer than 7 days
• Pain with sex (during or after)
• Pain with bowel movements
• Constipation/diarrhea around period
• Bloating (“endo belly”)
• Pain with urination (especially during period)
• Fatigue/exhaustion
• Nausea/vomiting with periods
• Headaches/migraines around period
• Trouble getting pregnant
• Miscarriage history
• Told it’s “normal cramps”
• Told it’s “stress/anxiety”
• Imaging came back “normal”

Other Symptoms?

“What are your top symptoms, when do they happen in your cycle, and what do they keep you from doing?”

NextSave and Resume Later

Section 2: Offer Your Observations

Instructions: Briefly describe what you’ve noticed and how you’re feeling using specific, fact-based language.

Focus: Shifting Awareness into Communication

• Describe pain with specifics: location, timing, triggers, severity (0–10), and what helps/doesn’t help.
• Share functional impact: missed work/school, sleep disruption, intimacy strain, ER/urgent care visits.
• Note what you’ve already tried (NSAIDs, heating pad, birth control, pelvic PT, diet changes) and what happened.
• Name your concern clearly: “I’m concerned about endometriosis” or “I want to rule it out.”

Empowerment Goal: Speak in clear, documented facts so your symptoms are taken seriously and acted on.

Offer Observations

Describe your pain and symptoms in your own words. Include timing in your cycle, severity, triggers, and how it affects your daily life. What questions do you have about what might be causing this?

Provider Questions

List any questions you want to ask your provider about endometriosis.

NextSave and Resume Later

Section 3: Outline What You Need

Instructions: Select or write in what you need from your provider today.

Focus: Defining Your Expectations & Needs

• Request a step-by-step plan: what you’re ruling in/out, what tests help, what treatments are options, and what happens if symptoms continue.
• Request symptom relief now (pain control plan) while evaluation is happening.
• Request referrals when needed (endometriosis specialist, minimally invasive gynecologic surgeon, pelvic pain specialist).
• Ask for documentation and follow-up timelines.

Empowerment Goal: Leave with a plan that includes relief, next steps, and a timeline—so you’re not stuck “waiting and suffering.”

What I Need

• Clear explanation of possible causes of my symptoms
• Pain management plan I can start now
• Plan if imaging is “normal” but symptoms continue
• Referral to endometriosis/pelvic pain specialist
• Referral to minimally invasive gynecologic surgeon (if appropriate)
• Evaluation for overlapping conditions (fibroids, adenomyosis, ovarian cysts, pelvic floor dysfunction, IBS, bladder pain)
• Timeline for follow-up and what to expect
• Help with barriers to follow-up (cost, time, transportation, fear)
• Other:

Prepare questions for your provider such as those listed here.

Other:

What are your main needs and goals for this visit? Are there specific supports, referrals, or information you want to request?

NextSave and Resume Later

Section 4: Take Note – & Follow-Up

Instructions: Use this section during or after your appointment to document what was discussed and your next steps.

Focus: Transforming Advocacy into Accountability

• Document what was decided today (meds, referrals, tests, and follow-up date) so nothing gets lost after the visit.
• Write down timelines (when results are expected, when to reassess, when symptoms should improve).
• Track new or worsening symptoms and emotional changes between visits so you can report them clearly.
• Follow up if you don’t receive results or referrals by a specific date.

Empowerment Goal: Turn your symptoms into documented action steps so you can follow through and hold the care plan accountable.

What did your provider say or do this visit?

What actions, appointments, tests, or resources are planned? Include timeline, follow-up date, and how you will receive results.

Offer your say

Track any new symptoms, pain changes, or emotional changes between visits.

NextSave and Resume Later

Sample Advocacy Script

Rooted in Violet & Co. believes self-advocacy is not a skill you’re born with—it’s a practice you grow into.

Sample Script

“My period pain is not manageable with over-the-counter medication and it affects my daily functioning. I need a plan for evaluation and relief.”

“I’ve been tracking my symptoms across my cycle. My pain is usually ____/10 and my worst is ____/10. It affects my ability to function for about ____ days a month. I’m concerned about endometriosis and I want a clear evaluation and plan.”

“I understand imaging can be normal with endometriosis. If my ultrasound is normal, what is our next step?”

“What is our plan for pain control right now while we investigate?”

“I’d like a referral to a clinician who specializes in endometriosis/pelvic pain.”

“Please document our conversation, my symptoms, and next steps in my chart.”

Section 6: Consent & Submission

Disclaimer *

• I understand this form is for my personal advocacy and not a substitute for medical advice.

The information provided in this Violet Sheet and all Rooted in Violet & Co. resources is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read or used from Rooted in Violet & Co. Rooted in Violet & Co. does not provide medical care, diagnosis, or treatment. The content is designed to support, not replace, the relationship that exists between you and your healthcare providers. If you think you may have a medical emergency, call your doctor, 911, or your local emergency number immediately. Your privacy is important to us. Any personal information you share through our forms or resources will be kept confidential and used solely for the purpose of supporting your wellness journey. We will never sell or share your information without your consent. By using this resource, you acknowledge and agree that Rooted in Violet & Co. is not liable for any decisions or actions you take based on the information provided.

Email *

Email

Confirm Email

Please provide your email to receive a copy of your completed form.

Rooted in Violet & Co. believes self-advocacy is not a skill you’re born with—it’s a practice you grow into.

Send to My EmailSave and Resume Later