My girlfriend had endometriosis after a hysterectomy 9yrs ago today she says symptoms are back and her belly is swelling leg is hurting back pain she refuses to go to hospital, when do I know when to take her?

Why hasn't her doctor been informed of her symptoms? That would be the first course of action. If she cannot see him immediately, then she goes to the hospital NOW!

When do you know to take her? Uh... now? When she's having abdominal pain it is time to get it looked at.