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This systematic review and meta-analysis evaluated the association between endometriosis staging, using rASRM or ENZIAN classifications, and various pain symptoms reported by patients. The researchers analyzed data from eight studies involving women with endometriosis, focusing on dysmenorrhea, dyspareunia, chronic pelvic pain, dyschezia, and dysuria measured via validated tools. Key findings indicated that while dysmenorrhea presented with the highest mean pain intensity, this intensity did not significantly differ between early (stages I/II) and advanced (stages III/IV) disease stages according to rASRM criteria. However, chronic pelvic pain was found to be more frequent in advanced stages, whereas dysuria showed the lowest pain intensity scores. This paper is centrally about endometriosis — specifically examining how clinical staging correlates with different types and intensities of pain symptoms in affected patients.
Abstract
OBJECTIVE: To evaluate the association between the endometriosis staging and the type and intensity of pain reported by patients, describing the pain intensity across different pain types. DATA SOURCES: On January 27, 2025, a systematic search was conducted in PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library. The search terms included endometriosis, pain, dysmenorrhea, dyspareunia, pelvic pain, dyschezia, dysuria, and classification. METHODS OF STUDY SELECTION: Eligible studies examined women with endometriosis, assessing how endometriosis staging (rASRM or ENZIAN classification) correlated with pain symptoms (dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain) measured with validated tools. TABULATION, INTEGRATION, AND RESULTS: Two reviewers extracted data independently, with a third verifying results. Pain scores were log-transformed to stabilize variance, and proportions of women with advanced endometriosis were analyzed on the logit scale. Given high heterogeneity, random-effects models with restricted maximum likelihood were used. Of 2,527 records, 112 studies were reviewed and eight met inclusion criteria (seven using rASRM, one using ENZIAN). Dysmenorrhea showed the highest mean intensity (6.61, 95%CI: 4.43-10.10), while dysuria was lowest (1.08, 95%CI: 0.62-1.89). Pain intensity did not differ significantly between rASRM stages I/II and III/IV (p > 0.05), though chronic pelvic pain was more frequent in advanced disease (p < 0.05). CONCLUSION: Dysmenorrhea is linked to higher pain intensity in women with endometriosis, while dysuria is linked to lower intensity. Pain intensity is not associated with the rASRM stage; however, chronic pelvic pain seems more prevalent in advanced stages of the disease.
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OBJECTIVE: To evaluate the association between the endometriosis staging and the type and intensity of pain reported by patients, describing the pain intensity across different pain types. DATA SOURCES: On January 27, 2025, a systematic search was conducted in PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library. The search terms included endometriosis, pain, dysmenorrhea, dyspareunia, pelvic pain, dyschezia, dysuria, and classification. METHODS OF STUDY SELECTION: Eligible studies examined women with endometriosis, assessing how endometriosis staging (rASRM or ENZIAN classification) correlated with pain symptoms (dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain) measured with validated tools. TABULATION, INTEGRATION, AND RESULTS: Two reviewers extracted data independently, with a third verifying results. Pain scores were log-transformed to stabilize variance, and proportions of women with advanced endometriosis were analyzed on the logit scale. Given high heterogeneity, random-effects models with restricted maximum likelihood were used. Of 2,527 records, 112 studies were reviewed and eight met inclusion criteria (seven using rASRM, one using ENZIAN). Dysmenorrhea showed the highest mean intensity (6.61, 95%CI: 4.43-10.10), while dysuria was lowest (1.08, 95%CI: 0.62-1.89). Pain intensity did not differ significantly between rASRM stages I/II and III/IV (p > 0.05), though chronic pelvic pain was more frequent in advanced disease (p < 0.05). CONCLUSION: Dysmenorrhea is linked to higher pain intensity in women with endometriosis, while dysuria is linked to lower intensity. Pain intensity is not associated with the rASRM stage; however, chronic pelvic pain seems more prevalent in advanced stages of the disease.
Descrição
Copyright © 2025. Published by Elsevier Inc.
Palavras-chave
endometriosis dysmenorrhea chronic pelvic pain ASRM ENZIAN
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