Cyclic Pain Research Articles

Antenatal ultrasound diagnosis of huge fetal hydrometrocolpos secondary to imperforate hymen and successful postnatal treatment: a case report

Abstract Objectives Hydrometrocolpos is a pelvic cystic mass representing the distension of the vagina and uterus due to obstructive congenital anomalies of the female causing accumulation of fluid secretions in the vagina and endometrial cavity. Prenatal diagnosis is uncommon and usually noticed during the adolescent period for failure to see menses with cyclic abdominal pain, abdominal mass, and local compressive symptoms. Late diagnosis after delivery of newborns with this condition results in poor outcomes from local compressive symptoms. Case presentation Here, we present a case diagnosed with congenital hydrometrocolpos at 39 weeks of gestation during routine third-trimester ultrasound scanning. The newborn was delivered vaginally and huge hydrometrocolpos secondary to imperforate hymen was diagnosed postnatally, and a hymenectomy was done and the newborn was discharged and improved from the hospital. Conclusions Although congenital hydrometrocolpos occurs rarely, it is also better to suspect prenatally in a female fetus with a cystic pelvic mass. Antenatal ultrasound diagnosis of this condition will help to make decisions early and to prevent further complications which might occur both intrauterine and after birth.

Unresolving cyclic pelvic pain in young women due to rare structural uterine anomalies: a case series

BackgroundThere are many causes for cyclic pelvic pain unresponsive to anti-spasmodic medications in young women. An uncommon, although significant, association in patients presenting with such symptoms is structural uterine anomalies with rudimentary functional cavities. Ultrasound is the first-line modality for the investigation of dysmenorrhea, and the radiologist may be the first person to identify such an underlying condition in the patient. However, transabdominal ultrasound may provide only limited information. Magnetic resonance imaging (MRI) is the imaging modality of choice in such situations due to its high soft tissue resolution and multiplanar capability. This case series is unique in that it primarily highlights the MR imaging of rare structural uterine anomalies in three young females suffering from severe dysmenorrhea, along with an imaging approach.Case presentationWe present three cases of unresolving cyclic pain in young nulliparous females who were radiologically diagnosed with three rare uterine structural anomalies—accessory and cavitated uterine mass, Mayer–Rokitansky–Küster–Hauser syndrome, and functional non-communicating rudimentary horn in a hemiuterus or unicornuate uterus, which were treated with resection leading to symptom relief.ConclusionIn young women with recurrent cyclic pelvic pain, uterine structural abnormalities with functioning cavities should be considered as an etiology and evaluated with MRI. Owing to the non-specific nature of causes of dysmenorrhea, a schematic approach to imaging is essential for identifying the various underlying gynecological conditions, thus aiding in the prompt management of the patient.

A Rare Case of Scar Edometriosis - Case Report

Background: Scar endometriosis is a rare condition seen in post LSCS or hysterectomy or obstetric procedure, where functional endometrial tissue is seen outside uterine cavity.
 Case: A 34 year old female presented with cyclic pain during menstruation at the Pfannenstiel incision at the scar site, associated with 5 * 5 cm lump in the parietal abdominal plan. On clinical examination and investigations, preoperatively, it was suggestive of scar endometriosis. After excision, HPE confirmed to be scar endometriosis with 2 cm clear margins.
 Discussion: Scar endometriosis is a very rare disorder whose incidence was reported to be 0.03–0.45%. Clinical suspicion of scar endometriosis is very important in the patients with chronic pain at scar site, which is usually missed and can often lead to longterm morbidity of the patients. With histopathological confirmation it becomes absolutely necessary to prove iatrogenic implantation theory which is well accepted.
 Conclusion: Clinical suspicion of scar endometriosis depending on clinical presentation and history of previous obstetric procedure is important for surgeons and excision of the lesion with good margins is the treatment of choice to prevent chronic morbidity in patients due to pain and recurrent surgery.

Hematocolpos Secondary to an Unrecognized Diagnosis of Hymenial Imperforation: A Case Report and Review of the Literature

A relatively rare congenital malformation, hematocolpos is the progressive accumulation of menstrual blood in the vaginal cavity at puberty. It is often the consequence of a hymen imperforation. It is clinically manifested by cyclic pelvic pain and primary amenorrhea and, more rarely, by a pelvic mass syndrome. The diagnosis is primarily clinical. Ultrasound and magnetic resonance imaging (MRI) are additional tests to confirm hematolcolpos and exclude other associated genitourinary malformations. Treatment consists of a hymenotomy to drain the hematocolpos. The age of discovery of hematocolpos varies from 13 to 14 years. We report a case of hematocolpos secondary to hymenal imperforation diagnosed in a 17-year-old girl with periodic pelvic pain, primary amenorrhea and a pelvic mass. A first ultrasound trap had evoked a large ovarian cyst but the repeat pelvic ultrasound in our hospital confirmed the diagnosis of hematocolpos.

Perineal scar endometriosis

The presence of ectopic endometrial tissue outside the uterine cavity is referred to as endometriosis. It is a harmless condition that is commonly seen in women of reproductive age. It can happen in both the pelvic and extra-pelvic areas. Endometriosis in an episiotomy scar is extremely rare, but due to local infiltration, it can cause significant morbidity in patients. The presence of the classic clinical triad of episiotomy history, tender nodule at the scar site, and cyclical pain can be used to diagnose this condition. Magnetic resonance imaging is a very useful imaging modality for diagnosing and assessing the lesion’s deeper extent.

A Narrative Review on the etiopathogenesis of Primary Dysmenorrhea with reference to Kastartava in Ayurveda literature

Objectives: Different dimensions of Primary Dysmenorrhea in Ayurveda literature has been explored and conceptualised it with the available physiological and anatomical understanding. Content: The concept of Primary Dysmenorrhea is better understood upon the basic understanding of Kastartava dating back to the phase of adolescence. 75% of adolescent girls’ experiences problems related to menstruation including delayed, irregular, painful, and heavy menstrual bleeding. Among these, painful menstruation or dysmenorrhea is the most common gynecological problem seen in reproductive age group. “Primary dysmenorrhea, one among its two types, is a cyclical lower abdominal or pelvic pain of sufficient magnitude so as to incapacitate day to day activities without any identifiable or evident pelvic pathology”. Ayurveda classics were reviewed to analyse the various aspects of Kastartava and correlated with research papers in terms of evidence-based physiological and anatomical advancements. Databases like PubMed, Scopus were searched using keywords like Shoola, Kastartava, Udavartini, Vatiki Yonivyapat, Dysmenorrhea, Primary Dysmenorrhea AND Ayurveda, Pain measurement, Quality of life, Inflammatory Markers, Prostaglandin theory. Summary: Various aspects of Shoola and Kastartava in Ayurveda from evidence-based advancements in Primary Dysmenorrhea based on recent researches have been put forward for basic evidence in relation with Pathophysiology of Primary Dysmenorrhea. Outlook: Understanding the pathophysiology of pain in Primary Dysmenorrhea with respect to the clinical presentation of Kastartava will give new insights to manage the clinical condition.

The role of catastrophizing in chronic cyclical pelvic pain: A systematic review and meta-analysis.

Dysmenorrhea (painful menstrual cramps) is one of the most common gynecological complaints in women and girls. Dysmenorrhea may be a condition itself or a result of another medical condition, including endometriosis and chronic pelvic pain. Research examining the relationship between menstrual pain ratings and catastrophizing has produced mixed results. To review and meta-analyze the relationship between catastrophizing and pain ratings of chronic cyclical pelvic pain. Cross-sectional, longitudinal, and intervention studies that reported the relationship between menstrual/pelvic pain and catastrophizing were included. Study populations had to include healthy menstruating persons or persons with a condition associated with cyclical pelvic pain including primary dysmenorrhea, endometriosis, and/or chronic pelvic pain. A systematic search of articles published since 2012 on PubMed, PsychInfo, CINHAL, and Medline was conducted in January and rerun in November of 2022. Search terms included cyclical pelvic pain, dysmenorrhea, endometriosis, pelvic pain, and catastrophizing. Data extraction was completed independently by two extractors and cross-checked for errors. A random-effects meta-regression was used to synthesize the data using restricted maximum likelihood. Twenty-five studies examining 4,540 participants were included. A random effects model found a meta-correlation between catastrophizing and pain of r = .31 (95% confidence interval: .23-.40) p < .001. Heterogeneity was large and significant (I2 = 84.5%, Q(24) = 155.16, p < .001). Studies that measured general pelvic pain rather than cyclical pelvic pain specifically and those that used multi-item rather than single-item measures of pain had significantly higher correlations. Age and depression did not moderate the relationship between catastrophizing and pain. A systematic review and meta-analysis found that catastrophizing had a small but significant positive association with pain ratings. Patients experiencing cyclical pelvic pain may benefit from interventions targeting the psychological management of pain. This meta-analysis was registered in PROSPERO on 14 January 2022. Registration number: CRD42022295328.

Mastalgia and associated breast diseases in a tertiary care center, Tamil Nadu: A cross-sectional study

Background: Mastalgia is the common breast condition among women. Mastalgia has highly variable prevalence which ranges 41–79%. It is more common in age group between 30 and 50 years. Mastalgia is approached according to its classification into three major categories, that is, cyclical pain, non-cyclical pain, and extra mammary pain. Breast pain ranges from mild to severe influencing the lifestyle of women affecting sexual relations, sleep pattern, and decreasing their daily life activities. Aim and Objectives: The aim of the study was to determine the incidence of benign and malignant breast disease in mastalgia. Materials and Methods: This cross-sectional study was conducted in Government Medical College, Sivagangai. Patients complaining of breast pain were examined. The data were compiled in an Excel worksheet, Epiinfo version 7.0 was used to analyze the data. Results: In our study, 100 patients complaining of breast pain were examined ranging from age 18 to 68 years. The mean age of the study population was 37.54 years and standard deviation of 9.077. Among 100 patients with mastalgia only 1 (1.64%) had malignancy which is insignificant and among rest 99 patients with mastalgia, 60.61% had benign breast diseases and 39.39% had no any breast lesions. Benign breast diseases are more commonly found in patients with mastalgia. Conclusion: Women having mastalgia can be reassured and some lifestyle modifications may aid the women. Hence, early detection of any breast disease in women having mastalgia and treating accordingly has considerable importance. Lifestyle modifications are needed in patients with mastalgia and they should come to facility to check and identify the issues and solve soon.

Rare Case of Bladder Endometriosis in a Post-hysterectomy Patient

Bladder endometriosis, a rare but well-known condition with a high risk of morbidity, affects the bladder. A 43-year-old woman presented with a history of recurrent cyclical discomfort during urination. The patient had undergone a non descent vaginal hysterectomy to address the same symptom. Upon examination, a nodule was discovered between the bladder and vaginal vault. The diagnosis of bladder endometriosis was confirmed through cystoscopy and an Magnetic Resonance Imaging (MRI). The nodule was removed via transurethal resection, and histology confirmed it as endometriosis. After 12 months of follow-up, the patient's postoperative symptoms had completely resolved. Hormonal therapy was initiated, and there were no residual urinary symptoms, chronic pain, or cyclical pain. Women reporting urinary symptoms, particularly those with a history of pelvic surgery, should undergo evaluation for bladder endometriosis. The diagnosis of bladder endometriosis should be considered in women experiencing dysuria and bladder discomfort. A high index of suspicion is required to establish the diagnosis.

Vaginal atresia in a patient with uterus didelphys

Background: Female reproductive tract abnormalities are generally encountered in 4%-7% of women. Various combinations have been described in the literature. Our case reports a rare female genital tract anomaly of the distal vagina combined with uterus didelphys. Case Presentation: A 15-year-old girl with lower vaginal atresia associated with uterus didelphys presented with cyclical progressively worsening abdominal pain and primary amenorrhea. Pelvic ultrasound (US) and magnetic resonance imaging (MRI) illustrated two separated uterine cavities associated with a distended fluid-filled structure ending in a blind pouch at the lower margin of the vagina. Conclusion: The presence of congenital anomalies of the female urogenital system may be suspected in the case of cyclical abdominal pain in young girls with primary amenorrhea. The use of US as a primary approach is recommended. MRI is preferred to specify the height and extent of vaginal aplasia as long as to guide the choice of the most appropriate surgical technique.

Double the trouble: A case report on uterine didelphys with unilateral cervical atresia

Genetic errors and teratogenic events during embryonic development can lead to congenital abnormalities of the female reproductive tract. Many patients are asymptomatic, while some have major abnormalities that can cause severe impairment of menstrual and reproductive functions. This case report focuses on Müllerian anomaly Class III, uterine didelphys, along with obstructed hemivagina and ipsilateral renal agenesis (the Herlyn–Werner–Wunderlich syndrome [HWWs]). The patient presented with cyclic pelvic pain due to the hematometra and hematocolpos. She initially underwent resection of the vaginal septum but had a recurrence of obstructive symptoms more than a year after vaginal surgery was performed. This prompted further evaluation with magnetic resonance imaging revealing cystic dilatation of the right uterine horn and a hypoplastic right vagina appearing to end blindly. The patient subsequently underwent hemihysterectomy. The right hemiuterus was noted to have a depression on its thickened inferior aspect, but no cervix was identified. This case is a variant of the classic HWWS, as there was cervical atresia on the right uterine corpus. A thorough preoperative evaluation and accurate intraoperative assessment of patients with Müllerian anomalies can decrease misdiagnoses, guide appropriate intervention, and decrease the risk of future reproductive complications.

Surgical Management of Mullerian Development Anomalies: 5 Years’ Experience of a Tertiary Care Center

Maldevelopment of the mullerian duct occurs in variety of forms and each anomaly is distinctive. This study was conducted to study clinical profile of patient with mullarian anomalies, different modalities used in diagnosis, and surgery performed to patients with mullerian duct anomalies. This was retrospective study of 23 patients who underwent surgery for different mullerian duct anomalies in last 5 years. There presenting problem, diagnostic modalities used, types of anomalies, other associated anomalies and different surgical management were evaluated. As per American Fertility society 6 patients belong to class I, 12 in class II and 5 in class III. Most of patients with Mayer Rokitansky Kuster Hauser (MRKH) syndrome had primary amenorrhea, patient of vaginal septum usually presents with cyclical abdominal pain, primary subfertility or dyspareunia. Patients with septate uterus had recurrent abortion 2D Ultrasonography (USG), Magnetic Resonance imaging (MRI) and hysteroscopy were modalities used for diagnosis of these defects. Patient of MRKH syndrome and vaginal agnesis were managed with vaginoplasty using amnion graft. Patients with septate uterus were managed with hysteroscopic septal resection. Septum resection was performed in all patients with transverse vaginal septum. Uterine anomalies are different groups of malformations with a broad spectrum of presentations. Management of each anomaly is individualized depending on the symptoms and fertility concerns.

Sequential treatment with transurethral resection and hormonal therapy for bladder endometriosis of vesicoureteric junction

Objective: To estimate the efficacy of sequential treatment of bladder endometriosis (BE) of the vesicoureteric junction using transurethral resection (TUR) and hormonal therapy. Design: Case report. Setting: Private multispecialty hospital. Patient: A multiparous woman presented with perimenstrual lower urinary tract symptoms, cyclic chronic pelvic pain, and left loin pain. Intervention[s]: Ultrasonography revealed marked left renal dilatation. Computed tomography confirmed the presence of a bladder mass. A diagnostic cystoscopy revealed compression of the left vesicoureteral junction. Complete TUR BE with release of chocolate material during resection, followed by ureteric double J stent insertion for 3 months, was performed. Histopathology confirmed the diagnosis of BE, followed by adjuvant hormonal therapy (dienogest) for 3 months. Followup for about 2 years revealed complete relief of the symptoms without any recurrence. Main Outcome Measure[s]. Success and recurrence rates of sequential TUR and hormonal therapy of BE of the vesicoureteric junction. Result[s]. TUR BE followed by adjuvant hormonal therapy was very effective in eradicating BE of the vesicoureteric junction in a safe manner without recurrence on follow-up for 2 years. Conclusion[s]. BE of the vesicoureteric junction can be properly treated by sequential TUR and hormonal therapy without recurrence over a 2-year follow-up.

Painful Nodules and Chronic Abdominal Pain: An Unusual Cause

Question: A 48-year-old woman with a history of locally treated left second toe melanoma and a previous cesarean section (C-section) presented for evaluation of cyclic abdominal pain of several years’ duration. Her discomfort was localized to the right lower quadrant associated with her menstrual period. Physical examination revealed 2 tender small nodules, 1 in the right lower quadrant and 1 in the midline approximately at the level of her prior C-section scar. She did not notice any specific change in the size of these nodules associated with her menstrual period. Computed tomography imaging of the abdomen/pelvis performed at an outside institution demonstrated 2 nodules along the abdominal wall associated with the musculature measuring 2.2 and 1.5 cm in diameter (Figure A and B). Locally, a laparoscopy was normal, revealing no evidence of endometriosis. Given her previous history of melanoma and to also rule out the possibility of desmoid tumor, ultrasound-guided biopsy was performed. A representative histopathology image from fine-needle aspiration is shown in Figure C.

Surgical Treatment of Catamenial Chest Pain: Excision of diaphragmatic endometriosis during robot-assisted laparoscopic surgery.

10% of women of reproductive age are affected by endometriosis, and diaphragmatic endometriosis represents 1-1.5% of these cases. Diaphragmatic endometriotic lesions often require surgical treatment. This video aims to demonstrate the appearance of diaphragmatic endometriosis and describe our experience with robot-assisted laparoscopic excision of full thickness diaphragmatic endometriosis. The patient was a 37-year-old female with the complaint of cyclical right shoulder pain (for 1 year). She previously had caesarean section scar and umbilical endometriosis excision procedures. The magnetic resonance imaging (MRI) of the abdomen highlighted three endometriotic nodules, one of which was described as full thickness on the right hemi-diaphragm. The patient underwent a robot-assisted laparoscopic endometriosis surgery as a joint procedure between the gynaecology and general surgery teams. The falciform ligament was completely divided to obtain full views of the endometriotic lesions on the diaphragm. Superficial diaphragmatic lesions were first excised. The larger deep nodule, which was described on the MRI, was then excised with the full thickness of diaphragm. Pleural cavity was entered intentionally to achieve complete excision of the nodule. Laparoscopic assessment of the right lower pleural cavity through this opening did not show any endometriotic lesions. After the excision, the diaphragm was repaired with a barbed suture. Negative pressure suction of the pleural cavity was performed at the end of this repair instead of using a chest tube. The patient was discharged on the 3rd day with no complications encountered. Histopathological examination confirmed endometriosis. The patient was asymptomatic three months after surgery. Robotic-assisted surgery is an easy and safe choice especially in such challenging dual compartment surgeries by providing a 3D view that abolishes sensory loss and increases depth perception, providing better manoeuvrability with tremor absence.

An Inguinal Endometriosis without Any Other Pelvic Endometriosis Mimicking Direct Inguinal Hernia: A Case Report

Inguinal endometriosis is a rare disease. Patients with inguinal endometriosis usually exhibit cyclic inguinal pain with a cyclic change in the size of the inguinal mass. It is more often found on the right side and commonly accompanies concomitant endometriosis lesions on pelvic organs or peritoneum. We report a case of inguinal endometriosis without any of the usual characteristics. A 48-year-old with non-severe dysmenorrhea and pelvic pain presented a left inguinal mass, palpable only when standing. Under the impression of direct inguinal hernia, laparoscopic herniorrhaphy was performed. Intraoperative laparoscopic findings revealed no other endometriosis lesion on the pelvic organ or in the abdominal cavity, and the histopathologic report confirmed it was endometriosis. Thorough inspection and excision of endometriosis lesions in the pelvic cavity are crucial for treatment. Therefore, an appropriate surgical plan following accurate preoperative diagnosis is important. If the intraoperative evaluation of endometriosis was not enough, postoperative gynecologic assessment is strongly recommended.

Haematocolpos and Secondary Hematometra Due to Imperforate Hymen: Diagnosis and Treatment

BackgroundImperforate hymen is an uncommon congenital anomaly of the female genital tract and is rarely diagnosed in newborns. An imperforate hymen is a cause of primary amenorrhea. Case DescriptionA 12-year-old girl was admitted to the pediatric outpatient clinic with cyclic abdominal pain for eight days. She had lower abdominal pain with dysuria and constipation for the previous six weeks. There is a bulging mass on the perineal that appears when straining. Fever, nausea, vomitus, abdominal enlargement, and leucorrhea were denied; breast enlargement since 12 years old with no history of menarche. The patient vital signs were normal. On physical examination obtained, lower abdominal pain and tender suprapubic mass were palpable. The pubertal status was normally secondary sexual characteristics. An interlabial mass was found protruding from the introitus vagina and the hymen intact on inspection of the external genitalia. Laboratory and urinalyses revealed normal. Hematometra and hematocolpos were found on abdominal ultrasonography, which led to the diagnosis of imperforate hymen. Therefore, a hymenectomy was performed and evacuated 520 ml of dark red blood. The patient’s condition was good, and she had regular menstruation. ConclusionsImperforate hymen is an easy diagnosis, but sometimes clinicians are oblivious to including this in the differential diagnosis of lower abdominal pain in pubescent girls with primary amenorrhea. Also, a lack of awareness about the importance of external genitalia examination as part of routine physical examination in children and adolescents makes this diagnosis easily missed or delayed.

A case report of an endometriosis cyst at cesarean scar defect and review of literature

BackgroundCesarean scar defect (CSD) presents as a cystic defect that connects the uterine cavity at the site of the previous cesarean section (CS). Endometriosis refers to the discovery of endometrial glands and stroma outside the uterine cavity. Cases of endometriosis cysts at CSD have not been reported.Case presentationIn this article, we will present a patient with an endometriosis cyst at CSD with symptoms of a prolonged menstrual cycle, periods without cyclic abdominal pain, and a history of cesarean delivery. The gynecologic ultrasound showed a CSD and a mixed mass in the right front of the uterus. After about 1 month, the tumor grew from a diameter of 4.75 cm to 8.06 × 6.23 × 3.66 cm. The patient eventually had an operation, which revealed a mass protruding from the incision in the anterior uterine wall, which was attached to the anterior uterine wall by a thin tip with a smooth surface. Intraoperative rapid cytopathology suggested that endometrial glands were seen within the smooth muscle tissue, similar to endometriosis. Subsequently, the patient underwent resection of the endometriotic cyst. Final paraffin pathology showed smooth muscle with visible endometrial glands and old hemorrhage, and a one-year follow-up showed no recurrence of endometriosis cysts at CSD.ConclusionsEndometriosis cysts at CSD are very rare. The clinical symptoms may be less obvious, and the diagnosis relies mainly on the patient’s previous surgical history and imaging. A finding of a pelvic mass in the location of the CSD, with or without symptoms of menstrual changes and intermittent abdominal pain, should be considered an endometriotic cyst at CSD. Surgical treatment is a good choice for this disease. Further studies are needed regarding the etiological mechanism of this case and why the mass enlarged rapidly in one mouth.

Emotional dysregulation in women with endometriosis with cyclical and non-cyclical chronic pelvic pain

BackgroundEndometriosis is a pathophysiological condition characterized by glands and stroma outside the uterus in regions such as the bladder, ureter, fallopian tubes, peritoneum, ovaries, and even in extra pelvic sites. One of the main clinical problems of endometriosis is chronic pelvic pain (CPP), which considerably affects the patients’ quality of life. Patients with endometriosis may, cyclically or non-cyclically (80% of cases) experience CPP. High levels of anxiety and depression have been described in patients with endometriosis related to CPP; however, this has not been evaluated in endometriosis women with different types of CPP. Therefore, the research question of this study was whether there is a difference in the emotional dysregulation due to the type of pain experienced by women with endometriosis?MethodsThis work was performed in the National Institute of Perinatology (INPer) in Mexico City from January 2019 to March 2020 and aimed to determine if there are differences in emotional dysregulation in patients with cyclical and non-cyclical CPP. 49 women from 18 to 52 years-old diagnosed with endometriosis presenting cyclical and non-cyclical CPP answered several batteries made up of Mini-Mental State Examination, Visual Analog Scale, Beck's Depression Inventory, State Trait-Anxiety Inventory, and Generalized Anxiety Inventory. Mann–Whitney U and Student’s t-test for independent samples to compare the difference between groups was used. Relative risk estimation was performed to determine the association between non-cyclical and cyclical CPP with probability of presenting emotional dysregulation.ResultsWe observed that patients with non-cyclical CPP exhibited higher levels of depression and anxiety (trait-state and generalized anxiety) than patients with cyclical pain, p < 0.05 was considered significant. No differences were observed in pain intensity, but there was a higher probability of developing emotional dysregulation (anxiety or depression) in patients with non-cyclical CPP. No differences were observed in cognitive impairment.ConclusionsOur data suggest that patients with non-cyclical (persistent) CPP present a higher emotional dysregulation than those with cyclical pain.

Cross-sectional study for derivation of a cut-off value for identification of an early versus delayed diagnosis of endometriosis based on analytical and descriptive research methods

BackgroundEndometriosis is a benign, hormone-dependent, chronic inflammatory gynecological disease accompanied by cyclic and acyclic pelvic pain and other complaints. The long lists of research recommendations in the AWMF guideline (Burghaus et al., Geburtshilfe Frauenheilkd 81:422–46, 2021) and ESHRE Endometriosis Guideline (ESHRE Endometriosis Guideline Development Group, Endometriosis: Guideline of European Society of Human Reproduction and Embryology, 2022) show that there is still a great need for research in all aspects of the disease. Diagnostic delay, defined as the mean time between symptom onset and confirmed diagnosis, is a particular problem associated with endometriosis. Some quantitative and qualitative studies have investigated possible reasons for this. A range of physician-related (Dixon et al., Br J Gen Pract 71:e668-e676, 2021; van der Zanden and Nap, Reprod Biomed Online 32:527–31, 2016) and patient-related factors (Sayer-Jones and Sherman, Health Psychol Behav Med 9:456–79, 2021) as well as stigmatization of the topic of menstruation by society have been identified (Kruckenberg, Frauenarzt 59:2–5, 2018; Seear, Soc Sci Med 69:1220–7, 2009). The consequences of the disease being diagnosed late (or too late) on the course of disease, the quality of life and the costs of the disease have already been documented in studies (Sims Int J Environ Res Public Health 18(15):8210, 2021; Surrey Adv Ther 37:1087–99, 2020).However, a systematically derived cut-off value that clearly distinguishes between short and long delay is still lacking. Therefore, the aim of our study was to derive a threshold value for the definition of a target corridor for endometriosis diagnosis based on descriptive and analytical methods.MethodsSince our review of the rather sparse publications on diagnostic delay did not yield satisfactory results, we used descriptive statistics and location parameters to calculate a cut-off value for German population data from the EndoCost study. Statistical methods were used for correlation analysis of shortDD versus longDD (correlation analysis and logistic regression) and group membership (discriminant analysis).ResultsFive years was identified as the cut-off value that significantly differentiated between shortDD and longDD based on various disease-related variables. This suggests that endometriosis should be definitively diagnosed within less than five years to minimize the risk of an unfavorable course of the disease.ConclusionOur findings confirmed that an early onset of endometriosis-related symptoms is the most important risk factor for a long diagnostic delay. Consequently, adolescent females should receive increased attention as an especially vulnerable group. Evidently, there is an urgent need to develop adequate concepts to improve the endometriosis education and care among this target group.