Clinical characteristics of endometriosis with and without dysmenorrhea diagnosed by laparoscopy

Abstract

Objective: This study aimed to delineate the clinical characteristics of endometriosis patients with dysmenorrhea and analyze the correlations between the presence, severity, and duration of dysmenorrhea and the severity of endometriosis. Methods: In this retrospective study, a total of 489 patients with endometriosis were enrolled who had undergone laparoscopic surgery or had been diagnosed with endometriosis during surgery for benign ovarian tumors. The patients were categorized into dysmenorrhea-positive and dysmenorrhea-negative groups based on the presence of symptoms at diagnosis. Subgroup analyses were further performed within the dysmenorrhea group based on pain severity (mild/moderate/severe) and duration (years). The impact of dysmenorrhea on endometriosis severity was evaluated using clinical, surgical, and histopathological parameters. Results: The proportion of patients without dysmenorrhea was 29.4%, while the proportion of patients with dysmenorrhea was 70.6%. Patients with dysmenorrhea were found to be younger, had significantly higher CA125 levels, and had a higher surgical stage. Patients with dysmenorrhea were observed to be more likely to experience infertility and deep infiltrating nodules. Elevated CA125 levels and infiltrating nodules were found to be independent risk factors for dysmenorrhea. CA125 levels and surgical staging significantly increased with the severity of dysmenorrhea. CA199 levels increased with dysmenorrhea duration but decreased in patients with >10 years of symptoms. The longer the duration of dysmenorrhea, the more frequently adenomyosis was observed. Conclusion: The presence, severity, and prolonged duration of dysmenorrhea are strongly associated with advanced endometriosis, infertility, and adenomyosis. Young women with dysmenorrhea warrant heightened clinical suspicion for endometriosis to avoid delayed diagnosis.