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
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Article info
Publication history
Published online: May 02, 2014
Accepted:
April 30,
2014
Received in revised form:
March 22,
2014
Received:
January 24,
2014
Footnotes
The opinions and assertions contained herein are the views of the authors and not to be construed as official or reflecting those of the Department of Defense or Department of the Army.
The authors report no conflict of interest.
Cite this article as: Heitmann RJ, Langan KL, Huang RR, et al. Premenstrual spotting of ≥2 days is strongly associated with histologically confirmed endometriosis in women with infertility. Am J Obstet Gynecol 2014;211:358.e1-6.
Identification
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Published by Elsevier Inc.
