Evaluation of the association between self-reported pre-operative symptoms with surgically diagnosed endometriosis
Elisabeth Reiser1, Georg Göbel2, Alexandra Perricos-Hess3
1Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Study Question:
Is there an association between pre-operative symptoms and intraoperatively described localization and size of endometriosis lesions as assessed by the #ENZIAN classification system?
Summary Answer:
Dyschezia is associated with any deep infiltrating endometriosis (DE) lesions; severe dyspareunia is associated with adenomyosis.
What Is Known Already:
Previous attempts to correlate the common symptoms of endometriosis to the size and localization of lesions have been of moderate success.
Study Design, Size, Duration:
This prospective, multicentre, non-interventional cross-sectional study was conducted between September 2022 and January 2024 at 18 endometriosis centres in Austria, Germany, and Switzerland, enrolling a total of 838 patients with endometriosis.
Participants/Materials, Setting, Methods:
The study included 521 patients with complete information on pre-operative symptoms and intraoperatively diagnosed endometriosis classified by the #ENZIAN classification system. Associations between symptoms and localization of endometriosis lesions were analysed.
Main Results And The Role Of Chance:
Nearly all patients (n = 513) (98.5%) suffered from dysmenorrhea whereas 294 (56.4%), 208 (39.9%), and 102 (19.6%) patients reported dyspareunia, dyschezia, and dysuria, respectively. Dyspareunia rated as ≥8 on a visual analogue scale was reported 3.5-fold more often in patients with adenomyosis only (OR 3.56 [1.38-9.17]) than in those without, while dyschezia was almost twice as likely in those with any form of DE (OR 1.86 [1.3-2.65]).
Limitations, Reasons For Caution:
A larger study population is needed to clinically define relevant sub-groups based on localization of lesions.
Wider Implications Of The Findings:
The findings of the present study identify adenomyosis as a strong driver of pain, especially dyspareunia, making awareness of its high prevalence of utmost importance. Few direct associations between symptoms and lesions were identified. Endometriosis-related symptoms, especially when chronic, are multi-factorial and cannot be readily correlated to specific lesion sites.
Study Funding/Competing Interest(S):
This study received no external funding and all the authors declare they have no conflicts of interest pertaining to this study.
Trial Registration Number:
Clinical Trials NCT05624567.
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