Symptoms Offer Clues in Endometriosis Management

Symptom Questionnaires Can Support Early Referral for Endometriosis Diagnosis

Key Points

Highlights: 

• Symptom questionnaires may help guide referrals for surgical evaluation of endometriosis, particularly when imaging fails to detect peritoneal lesions.

Importance:

• Early and accurate diagnosis of endometriosis remains challenging, especially for superficial peritoneal disease.
• This study underscores how detailed symptom questionnaires can bridge gaps in imaging and aid clinicians in identifying patients who may benefit from surgical referral.

What’s done here:

• This article is a retrospective comparative analysis of patient-reported symptoms in relation to endometriosis type and localization using the #ENZIAN classification.
• tudy assessed correlations between symptoms (dysmenorrhea, dyspareunia, dyschezia, pelvic pain, gastrointestinal symptoms) and lesion location.
• Distinct symptom patterns in bowel DIE evaluated and compared to other forms of endometriosis.

Key results:

• There were no differences in terms of overall symptoms between patients with different stages of endometriosis.
• Severe dyschezia was associated with bowel involvement, and dyspareunia was associated with adenomyosis.
• Chronic pelvic pain was lower in patients with deep infiltrating endometriosis affecting the bowels compared to patients with peritoneal or ovarian endometriosis.
• Gastrointestinal symptoms (nausea, diarrhea, bloating) were common across all groups, regardless of bowel involvement.
• Imaging modalities failed to identify superficial lesions responsible for significant symptoms.

Limitations and Strengths:

• Retrospective design and possible recall bias. Symptom severity reporting was subjective.
• The use of validated questionnaires across a large, well-classified surgical cohort and the ntegration of #ENZIAN classification for detailed anatomical correlation are strengths if the study.

From the Editor-in-Chief – EndoNews

"This study emphasizes the diagnostic value of patient-reported symptom profiles in managing endometriosis, particularly when imaging falls short in detecting peritoneal endometriosis.

The correlation of severe dyschezia with bowel involvement and dyspareunia with adenomyosis reinforces the importance of carefully mapping symptoms to guide surgical referral. While symptom questionnaires are not a substitute for advanced imaging or laparoscopy, they remain a pragmatic and underutilized tool for identifying patients who may benefit from earlier specialist evaluation. Integrating structured assessments into routine practice could help bridge the gap between symptom onset and diagnosis, improving patient outcomes in this often underdiagnosed condition."

Lay Summary

Non-invasive imaging techniques like transvaginal ultrasound and magnetic resonance imaging (MRI) are valuable for identifying deep infiltrating endometriosis (DIE) and ovarian endometriomas. However, these tools often fail to detectperitoneal lesions, which can also cause significant symptoms.

A new study published in Archives of Gynecology and Obstetrics highlights the potential of symptom questionnaires as an initial step to guide the diagnosis of endometriosis, and referrals for surgical evaluation.

Researchers retrospectively analyzed preoperative questionnaires from 233 patients with surgically and histologically confirmed endometriosis, classified using the #ENZIAN system.

The aim was to test the relationship between digestive symptoms and three groups of endometriosis patients, namely, those with peritoneal endometriosis with or without adnexal adhesions and adenomyosis, those with DIE, excluding the digestive system, and/or cystic endometriosis with or without peritoneal and adnexal adhesions and adenomyosis, and those with DIE affecting the digestive system with or without other localizations.

The study found no overall differences in symptom prevalence across three groups of patients—those with peritoneal endometriosis, those with DIE excluding bowel involvement, and those with DIE affecting the digestive system. However, severe dyschezia (pain with defecation) was strongly associated with bowel endometriosis, and dyspareunia was linked to adenomyosis. Notably, patients with bowel deep infiltrating endometriosis reported less chronic pelvic pain compared to those with peritoneal or ovarian disease.

These findings underscore the limitations of imaging alone and suggest that structured symptom questionnaires could help identify patients at risk of more complex disease, supporting timely referral for further investigation and surgical management.

The team was led by Dr. Thomas Römer from the Department of Obstetrics and Gynecology, Academic Hospital Cologne Weyertal, University of Cologne, in Cologne, Germany.

Research Source: https://pubmed.ncbi.nlm.nih.gov/40580252/