TiNMAN

This document contains a non-working example of the work-in-progress TiNMAN exploratory questions used to help identify the existance of endometriosis.

Important things to be aware of:

The first assessment asks all questions in strict order. After that questions are asked in random order but a dynamic skip list lets you keep it relevant by bypassing any that might not apply or are at a scoring extreme based on previous results. If a question is allocated to more than one study area then it will only be asked once.
There is no time limit on how long someone takes to complete an assessment.
This is neither a competition nor a test so there are no right or wrong answers.
Registered users would need to complete an assessment between every three and fourteen days to build their timeline.

To show any additional detailed question supporting text tap on the question's blue bubble.

Endometriosis is a chronic gynecological condition where patches of tissue similar to the endometrial tissue, the tissue that lines the inside of the uterus, grow outside the uterus, typically appearing on the pelvic lining, ovaries, uterosacral ligaments, bladder and bowel. These patches, also known as implants, can grow into deep, penetrating nodules or form cysts on the ovaries known as endometriomas that respond to hormonal changes and bleed during menstruation.

This question focuses on symptoms of endometriosis that can be shared with other conditions, in particular

severe period pain and abnormally heavy and prolonged or possibly continous menstrual bleeding
pain or discomfort internally within the pelvic area during or after sexual intercourse, often triggered by deep thrusting
problems with the bladder and urinary control that may or may not align with your menstrual cycle
chronic pelvic pain in the lower abdomen or back that may occur even when not menstruating
problems with fertility and difficulty conceiving, but only include this in your response choice if it is relevant.

To what extent have you experienced pain or discomfort as a result of symptoms of endometriosis that can be shared with other conditions?

The amount of endometrial tissue does not always correspond to the level of pain experienced by the individual. A small amount can be agonising in one case whilst a large amount can go unnoticed in another and not everyone displays symptoms.

The core symptoms of endometriosis are those that are not typically associated with other conditions. They often worsen just before and during menstruation due to hormonal changes causing inflammation of misplaced endometrial tissue and include

debilitating pelvic pain, more severe than normal menstrual cramping, that may begin days before bleeding starts and can persist throughout the entire menstrual cycle
ovulation pain felt specifically during the middle of the menstrual cycle
problems with the bladder and urinary control that worsen at the time of the menstrual cycle, tending to be peak in the days before and during a period
gastrointestinal issues such as bloating, painful bowel movements including with constipation or diarrhea, or nausea that occur in a regular monthly pattern, usually worsening in the days leading up to and during a period
tissue damage that extends beyond the pelvis, affecting the diaphragm, chest, and abdominal wall, especially after surgeries like C-sections, leading to possible pain or bleeding during menstruation in areas such as the chest, causing cough or shortness of breath, or from old surgical scars
endometrial-like tissue growing on or near pelvic nerves, often mimicking sciatica, and causing sharp, stabbing, tingling or throbbing pain as well as numbness, heaviness, weakness, or cramping that radiates down the buttocks, thighs, calves, or feet and worsens during menstruation
extreme fatigue to the point of physical exhaustion.

To what extent have you experienced core symptoms of endometriosis?

Cyclical dyschezia refers to painful bowel movements that occur in a regular monthly pattern, usually worsening in the days leading up to and during menstruation.

Endometriosis on the bowel often affects the lower part of the intestines and tissue can be

superficial and found on the surface of the bowel
deep infiltrating where tissue has penetrated the bowel wall, possibly leading to rectal bleeding that coincides with menstrual periods.

Symptoms can include

pain on opening your bowels
painful bowel movements, often described as sharp, stabbing, shooting, or razor-blade-like pain deep in the rectum or pelvis during defecation
bowel incontinence
profound painful bloating and flatulance
severe constipation and a feeling that you cannot empty your bowels fully in the days leading up to your period
painful diarrhoea and an occasional urgent need to evacuate your bowels suddenly during your period

If the time in your menstrual cycle coincided with the days before and during your period then how would you describe your experience of markedly increased bowel issues?

Your body tries to synchronise your sleep-wake cycle to cues from the environment, such as seasonally adjusting to when it gets light or dark outside, when you eat, and when you are physically active.

Depression is a persistent and severe condition whereby a person suffers from a heavy mental state of sadness and low mood which continues without any meaningful respite for weeks or more and significantly interferes with all aspects of daily life.

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