Case-control study to develop a questionnaire for early diagnosis of endometriosis

Secondary prevention of endometriosis with a simple questionnaire

Key Points

Highlights:

• Using a questionnaire to pinpoint women with endometriosis allowing them to get the diagnosis and start the appropriate treatment is extremely important.

Importance:

• A questionnaire for screening to identify young women with potential symptoms of endometriosis could facilitate the initial discussions between patients and physicians and could lead to early treatments to increase the patients’ reproductive potential.

What’s done here?

• The literature and selected risk factors, symptoms, and phenotypic traits of the women affected by endometriosis were reviewed to create a questionnaire
• The questionnaire was composed of 8 modules and 47 questions.
• A total of 51 women with endometriosis and 100 women without endometriosis enrolled in the study.
• The data was analyzed by conducting appropriate statistical analyses.

Key results:

• There is an increased risk of developing endometriosis for women who experienced food or drug allergies and who experienced severe acne during adolescence.
• Women who suffer from non-menstrual abdominal pain for more than 2–3 days per month and regularly experience some discomforts including constipation, incomplete defecation, and urinary urgency are at higher risk for developing endometriosis.
• For women who take pills to deal with severe menstrual pain or women who have a menstrual cycle shorter than 28 days, heavy bleeding or chronic pelvic pain are also at much higher risk to develop endometriosis.

Limitations of the study:

• Lack of evaluation with the laparoscopy for the women in the control group although they went through pelvic ultrasound.
• Association between some of the risk factors and endometriosis that was contradicting the literature, which led to some challenges for developing the questionnaire.

Lay Summary

Endometriosis, which affects 5–10% of women of reproductive age, is a chronic gynecological disease characterized by the presence of endometrial glands and stroma outside the uterus, associated with several discomforts such as pelvic pain, menstrual disorders, and infertility.

Ultrasound evaluation is the standard technique used for the diagnosis of pelvic endometriosis, but the complete diagnosis can be confirmed only upon a direct visualization of the lesions by laparoscopy and histopathological evaluation, which would require invasive procedures. Thus, endometriosis is not easy to diagnose, and its detection can take quite some time.

Early detection of endometriosis is crucial to prevent its most severe consequences such as infertility and chronic pelvic pain.

In this study, published in PlosOne, Ricci et al., aimed to create and validate a simple but effective questionnaire that could be used to identify women with endometriosis, allowing them to start their treatment without losing time.

To achieve their goal, the authors developed a questionnaire with the purpose of identifying patients at high risk for endometriosis, via elucidating the association with risk factors and symptomatology. The questionnaire was applied to a set of 151 women with the same ethnicity, of which 51 had endometriosis and 100 were healthy controls.  A step-down logistic regression analysis was then conducted to analyze the data and four main variables (chronic pelvic pain, dyspareunia, painful defecation, and acne) were selected to apply the model, which were found to be the optimal combination and achieved the best sensitivity (90.2%) and specificity (75%).

Ricci et al. believe that this questionnaire could be used as an effective tool for secondary prevention of endometriosis as well as an effective screening tool to allow young women to recognize potential symptoms of endometriosis that could lead to an early diagnosis, which would help to slow the course of the disease and might increase their reproductive potential.

Research Source: https://pubmed.ncbi.nlm.nih.gov/32226031