Pain Symptoms in Endometriosis: Value in Disease Prediction and Staging

Background: Endometriosis is a chronic condition commonly presenting with pain symptoms and infertility. Endometriosis can only be diagnosed definitively at laparocopy. In view of the absence of reliable tools that can establish the diagnosis in a non-invasive way, there is a strong need for clinical prediction. Objective: To investigate the value of pain symptoms in prediction and staging of endometriosis. Setting: Obstetrics and Gynaecology department, Cairo University hospital. Materials and Methods: This is a cross-sectional study that included 50 women scheduled for laparoscopy for various indications. All cases underwent a preoperative clinical evaluation with meticulous analysis and grading of pain symptoms (dysmenorrhoea, dyspareunia, chronic pelvic pain). On laparoscopy, endometriosis was searched for and patients were categorized into 2 groups according to the presence or absence of endometriosis. Laparoscopic staging of endometriosis was then conducted according to the Revised American Fertility Society (AFS) scoring. The primary outcome measures were the relation of pain symptoms to the presence of endometriosis and the stage of the disease. The relation of pain to disease associated adhesions was also assessed. Results: Laparoscopy was indicated as a part of infertility work up in 41 patients. Laparoscopic diagnosis of pelvic endometriosis was seen in 28 patients (56%). The frequency of endometriosis in infertile patients was 58.5% (24 patients). Stage I endometriosis was present in 5 patients, stage II was present in 8 patients, stage III was present in 10 patients and stage IV was present in 5 patients. The comparison of the presence and severity of both dysmenorrhoea & chronic pelvic pain between cases with and without endometriosis was statistically significant (p=0.02, 0.042 respectively). The presence and severity of dyspareunia was not statistically significant in women with and without endometriosis. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of dysmenorrhea, were 93, 36, 65, 80, 68 respectively and those of pelvic pain were 71, 45, 63, 56, 60. The presence and severity of both dysmenorrhoea and chronic pelvic pain was not statistically significant between the different stages of endometriosis. Comparison of the presence and severity of pelvic pain between patients with and without adhesions was statistically significant ( p=0.03). Conclusion: The frequency of endometriosis in infertile women is 58.5%. Dysmenorrhoea and chronic pelvic pain are frequent symptoms in patients with endometriosis but are not related to the disease stage. There is a strong association between the intensity of chronic pelvic pain and the presence of endometriosis-associated adhesions.