Non-Surgical Options for The Diagnosis of Endometriosis in Low-Resource Settings: A Comparative Study

Marlina D, Utomo A, Poernomo MAPD, Adriansyah PNA, Amri BS, Susilo AFP, Aziz MA
2025 · W7058573304
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This study found that dysmenorrhea, especially with onset more than three years after menarche, significantly increases the likelihood of endometriosis diagnosis in low-resource settings.

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This study investigated clinical characteristics associated with endometriosis to improve non-surgical diagnosis in low-resource settings. Researchers analyzed data from patients registered at a hospital in Indonesia between 2020 and 2024, using statistical methods to determine odds ratios for various symptoms. The results indicated that secondary dysmenorrhea, defined as pain starting more than three years after menarche, was significantly correlated with the condition, showing nearly 17.5 times higher odds compared to other factors. The authors conclude that tracking the onset timing of menstrual pain could serve as a valuable indicator for early detection without surgical intervention. This paper is centrally about endometriosis — specifically focusing on non-invasive diagnostic indicators and clinical symptom analysis.

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Abstract

Dina Marlina,1 Aditya Utomo,1 Megawati Al’badly Ponco Dewi Poernomo,2 Putri Nadhira Adinda Adriansyah,1 Beni Samsul Amri,2 Artha Falentin Putri Susilo,1 Muhammad Alamsyah Aziz1 1Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Bandung, West Java, Indonesia; 2Department of Obstetrics and Gynecology, Prof. Dr Margono Regional General Hospital, Faculty of Medicine, Jenderal Soedirman University, Purwokerto, Central Java, IndonesiaCorrespondence: Dina Marlina, Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Padjadjaran University, Jl. Pasteur No. 38, Pasteur, Kec. Sukajadi, Kota Bandung, Jawa Barat, 40161, Indonesia, Tel +6282120942012, Email [email protected]: Endometriosis, a chronic estrogen-dependent condition characterized by the implantation of tissue beyond the uterine cavity, impacts 10% of women of reproductive age. Endometriosis manifests through menstrual discomfort, chronic pelvic pain, dyspareunia, and cyclical digestive issues. It is additionally linked to infertility. Early diagnosis and effective treatment are crucial but remain limited in many settings. This study aims to identify specific clinical characteristics that could aid in the early diagnosis and treatment of endometriosis.Patients and Methods: The study conducted at Province General Hospital Margono, Indonesia, involved endometriosis patients who had registered from 2020 to 2024. Some inclusion and exclusion criteria are applied in this study. Statistical analysis was performed to determine the rate, odd ratio and prevalence ratio.Results: Our analysis indicates that women experiencing dysmenorrhea, particularly with an onset occurring more than three years after menarche, are significantly associated with endometriosis. Dysmenorrhea had nearly 17.5 times higher odds [OR 17.5, 95% CI 4.75– 64.4, p-value 0.00] of being correlated with endometriosis, and the onset of dysmenorrhea more than 3 years after menarche had 1.67 times higher [OR 2.790; CI 95%; 1.011– 7.698, p-value 0.045] of being associated with endometriosis.Conclusion: Multiple studies have shown that diagnosing endometriosis early is challenging due to its various symptoms. Our findings highlight the significance of dysmenorrhea characteristics, particularly its onset timing, as potential indicators of endometriosis. This findings suggest that incorporating dysmenorrhea onset into clinical assessments may enhance non-surgical diagnostic approaches, facilitating earlier detection and management of endometriosis.Keywords: predictive model, menstrual cycle, endometriosis, non-invasive
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International Journal of Women's Health (May 2025) Non-Surgical Options for The Diagnosis of Endometriosis in Low-Resource Settings: A Comparative Study Abstract Dina Marlina,1 Aditya Utomo,1 Megawati Al’badly Ponco Dewi Poernomo,2 Putri Nadhira Adinda Adriansyah,1 Beni Samsul Amri,2 Artha Falentin Putri Susilo,1 Muhammad Alamsyah Aziz1 1Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Bandung, West Java, Indonesia; 2Department of Obstetrics and Gynecology, Prof. Dr Margono Regional General Hospital, Faculty of Medicine, Jenderal Soedirman University, Purwokerto, Central Java, IndonesiaCorrespondence: Dina Marlina, Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Padjadjaran University, Jl. Pasteur No. 38, Pasteur, Kec. Sukajadi, Kota Bandung, Jawa Barat, 40161, Indonesia, Tel +6282120942012, Email [email protected]: Endometriosis, a chronic estrogen-dependent condition characterized by the implantation of tissue beyond the uterine cavity, impacts 10% of women of reproductive age. Endometriosis manifests through menstrual discomfort, chronic pelvic pain, dyspareunia, and cyclical digestive issues. It is additionally linked to infertility. Early diagnosis and effective treatment are crucial but remain limited in many settings. This study aims to identify specific clinical characteristics that could aid in the early diagnosis and treatment of endometriosis.Patients and Methods: The study conducted at Province General Hospital Margono, Indonesia, involved endometriosis patients who had registered from 2020 to 2024. Some inclusion and exclusion criteria are applied in this study. Statistical analysis was performed to determine the rate, odd ratio and prevalence ratio.Results: Our analysis indicates that women experiencing dysmenorrhea, particularly with an onset occurring more than three years after menarche, are significantly associated with endometriosis. Dysmenorrhea had nearly 17.5 times higher odds [OR 17.5, 95% CI 4.75– 64.4, p-value 0.00] of being correlated with endometriosis, and the onset of dysmenorrhea more than 3 years after menarche had 1.67 times higher [OR 2.790; CI 95%; 1.011– 7.698, p-value 0.045] of being associated with endometriosis.Conclusion: Multiple studies have shown that diagnosing endometriosis early is challenging due to its various symptoms. Our findings highlight the significance of dysmenorrhea characteristics, particularly its onset timing, as potential indicators of endometriosis. This findings suggest that incorporating dysmenorrhea onset into clinical assessments may enhance non-surgical diagnostic approaches, facilitating earlier detection and management of endometriosis.Keywords: predictive model, menstrual cycle, endometriosis, non-invasive

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endometriosischronic_pelvic_paindysmenorrheadyspareuniainfertility

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