Advertisement

Premenstrual spotting of ≥2 days is strongly associated with histologically confirmed endometriosis in women with infertility

      Objective

      The purpose of this study was to assess the prevalence of endometriosis in women with premenstrual spotting and to determine the predictive value of this symptom in the diagnosis of endometriosis.

      Study Design

      We conducted a retrospective cohort study of 80 consecutive women who presented to the infertility clinic for evaluation and who subsequently underwent laparoscopic assessment for infertility with or without pelvic pain. Our main outcome measure was the presence or absence of histologically confirmed endometriosis in women with and without premenstrual spotting.

      Results

      Endometriosis was significantly more prevalent in subfertile women who reported premenstrual spotting for ≥2 days relative to women without this symptom (89% [34/38 women] vs 26% [11/42 women]; P < .0001). Multinomial logistic regression analysis demonstrated the presence of premenstrual spotting for ≥2 days to be associated significantly with the presence of endometriosis (odds ratio, 16; 95% confidence interval, 3.9–65.4; P < .01) and red vesicular lesion type (odds ratio, 52.6; 95% confidence interval, 8.6–323.1; P < .001).

      Conclusion

      In this cohort of women with infertility, premenstrual spotting of ≥2 days was associated strongly with histologically confirmed endometriosis and a better predictor than dysmenorrhea or dyspareunia of finding endometriosis at laparoscopy. Premenstrual spotting of at least 2 days was also associated strongly with both higher stage disease and the red vesicular peritoneal endometriosis phenotype.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Eskenazi B.
        • Warner M.L.
        Epidemiology of endometriosis.
        Obstet Gynecol Clin North Am. 1997; 24: 235-258
        • Kennedy S.
        • Bergqvist A.
        • Chapron C.
        • et al.
        ESHRE guideline for the diagnosis and treatment of endometriosis.
        Hum Reprod. 2005; 20: 2698-2704
        • Howard F.M.
        The role of laparoscopy in chronic pelvic pain: promise and pitfalls.
        Obstet Gynecol Surv. 1993; 48: 357-387
        • Cox L.
        • Ayers S.
        • Nala K.
        • Penny J.
        Chronic pelvic pain and quality of life after laparoscopy.
        Eur J Obstet Gynecol Reprod Biol. 2007; 132: 214-219
        • Nnoaham K.E.
        • Hummelshoj L.
        • Webster P.
        • et al.
        Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries.
        Fertil Steril. 2011; 96: 366-373.e8
        • D'Hooghe T.M.
        • Debrock S.
        Endometriosis, retrograde menstruation and peritoneal inflammation in women and in baboons.
        Hum Reprod Update. 2002; 8: 84-88
        • Rogers P.A.
        • D'Hooghe T.M.
        • Fazleabas A.
        • et al.
        Priorities for endometriosis research: recommendations from an international consensus workshop.
        Reprod Sci. 2009; 16: 335-346
        • Okaro E.
        • Condous G.
        • Khalid A.
        • et al.
        The use of ultrasound-based ‘soft markers’ for the prediction of pelvic pathology in women with chronic pelvic pain: can we reduce the need for laparoscopy?.
        BJOG. 2006; 113: 251-256
        • Eskenazi B.
        • Warner M.
        • Bonsignore L.
        • Olive D.
        • Samuels S.
        • Vercellini P.
        Validation study of nonsurgical diagnosis of endometriosis.
        Fertil Steril. 2001; 76: 929-935
        • The American Fertility Society
        Revised American Fertility Society classification of endometriosis: 1985.
        Fertil Steril. 1985; 43: 351-352
        • Wentz A.C.
        Premenstrual spotting: its association with endometriosis but not luteal phase inadequacy.
        Fertil Steril. 1980; 33: 605-607
        • Cramer D.W.
        • Wilson E.
        • Stillman R.J.
        • et al.
        The relation of endometriosis to menstrual characteristics, smoking, and exercise.
        JAMA. 1986; 255: 1904-1908
        • Missmer S.A.
        • Hankinson S.E.
        • Spiegelman D.
        • et al.
        Reproductive history and endometriosis among premenopausal women.
        Obstet Gynecol. 2004; 104: 965-974
        • Matalliotakis I.M.
        • Cakmak H.
        • Fragouli Y.G.
        • Goumenou A.G.
        • Mahutte N.G.
        • Arici A.
        Epidemiological characteristics in women with and without endometriosis in the Yale series.
        Arch Gynecol Obstet. 2008; 277: 389-393
        • Jansen R.P.
        Endometriosis symptoms and the limitations of pathology-based classification of severity.
        Int J Gynaecol Obstet. 1993; 40: S3-S7
        • Nisolle M.
        • Donnez J.
        Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities.
        Fertil Steril. 1997; 68: 585-596
        • Vernon M.W.
        • Beard J.S.
        • Graves K.
        • Wilson E.A.
        Classification of endometriotic implants by morphologic appearance and capacity to synthesize prostaglandin F.
        Fertil Steril. 1986; 46: 801-806
        • Cunha-Filho J.S.
        • Gross J.L.
        • Bastos de Souza C.A.
        • et al.
        Physiopathological aspects of corpus luteum defect in infertile patients with mild/minimal endometriosis.
        J Assist Reprod Genet. 2003; 20: 117-121
        • Lyneham R.C.
        • Korda A.R.
        • Shutt D.A.
        • Smith I.D.
        • Shearman R.P.
        The effect of intra-uterine prostaglandin F-2alpha on corpus luteum function in the human.
        Prostaglandins. 1975; 9: 431-442
        • Marchino G.L.
        • Gennarelli G.
        • Enria R.
        • Bongioanni F.
        • Lipari G.
        • Massobrio M.
        Diagnosis of pelvic endometriosis with use of macroscopic versus histologic findings.
        Fertil Steril. 2005; 84: 12-15
        • Shen L.
        • Wang Q.
        • Huang W.
        • Yuan Q.
        • Huang Y.
        • Lei H.
        High prevalence of endometrial polyps in endometriosis-associated infertility.
        Fertil Steril. 2011; 95: 2722-2724.e1
        • Kim M.R.
        • Kim Y.A.
        • Jo M.Y.
        • Hwang K.J.
        • Ryu H.S.
        High frequency of endometrial polyps in endometriosis.
        J Am Assoc Gynecol Laparosc. 2003; 10: 46-48