Pain alone is not a specific predictor for endometriosis diagnosis

Although pain is one of the most common symptoms of women with endometriosis, it is not proportional to the severity and stage of the disease.

Key Points

Highlights:

• Clinicians should consider carefully women presenting with suspected endometriosis because of non-specific symptoms of the disease.

Importance:

• Endometriosis is a mysterious disease that still has delays in diagnosis due to its non-unique clinical findings.   

What’s done here?

• This retrospective cohort was conducted at a public tertiary women’s hospital to define the causes for initial specialist referral among patients with endometriosis.
• Patients aged between 18 and 50 years who underwent laparoscopy or laparotomy for endometriosis were included.
• Operation records were reviewed to determine the severity of the disease and to define causes for initial referral to the general gynecology, endosurgery, gyne-oncology, reproductive medicine outpatient departments.

Key results:

• A total of 300 patients were included, 90 (30%) had Stage IV by r-ASRM classification.
• Pain (37.0%), infertility/subfertility (17.0%), and their combination along with irregular bleeding and/or bowel symptoms (23.3%) were the most common initial referral causes.
• Less than 10% were referred to investigate ovarian cyst/mass without symptoms.
• The presence of ovarian cysts or masses was more likely to have severe disease.
• There was no correlation between the severity of disease and the presence of pain.

Limitations and Strengths:

• The most important strength is the large study population.
• The possibility of incomplete or incorrect documentation of intraoperative findings and operation reports is the limitation.

Lay Summary

The most common symptoms and signs of women with endometriosis include dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. However, diagnostic delay still occurs due to the broad clinical spectrum of the disease and the absence of non-invasive diagnostic biomarkers.

Gordon et al., from Australia, published a study entitled “When pain is not the whole story: Presenting symptoms of women with endometriosis” in the journal "Australian and New Zealand Journal of Obstetrics and Gynaecology". The authors sought to evaluate the causes for referral of the patients with endometriosis to general gynecology, endosurgery, gyne-oncology, reproductive medicine outpatient departments.

The study included women with surgically confirmed endometriosis along with the reviewed operation records. The authors also classified the severity of endometriosis based on the revised American Society for Reproductive Medicine (r-ASRM) classification system. Pain, infertility/subfertility, and a combination of pain and/or infertility and/or ovarian cyst and/or irregular bleeding and/or bowel symptoms were the main indications for initial referral.

Another complaint of these patients on consultation was the presence of non-malignant ovarian cyst/mass without symptoms.

Although women with ovarian cysts or masses were more likely to have severe disease, no correlation was found to be between the severity of disease and the presence of pain.

“More than a third of patients with Grade IV disease were referred without any mention of pain symptoms, encouraging clinicians to adopt a broader approach to endometriosis” the authors concluded.   

Research Source: https://pubmed.ncbi.nlm.nih.gov/35092607/