When pain is not the whole story: Presenting symptoms of women with endometriosis

Hannah G Gordon, Hannah Gordon, Samantha Mooney, Samantha S Mooney, Isabelle C Conroy, Isabelle Conroy, Sonia R Grover, Sonia Grover
The Australian & New Zealand journal of obstetrics & gynaecology · 2022 · vol. 62(3) , pp. 434–438 · doi:10.1111/ajo.13482 · PMID:35092607 · W4210320295
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study identified that while pelvic pain is a common referral reason for endometriosis, over a third of women with severe disease presented without pain symptoms, suggesting a need for broader diagnostic considerations.

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Abstract

BACKGROUND: Endometriosis affects one in nine Australian women of reproductive age, and is often associated with pain and infertility. However, many women may be asymptomatic, or present with alternative symptoms. AIM: To identify reasons for initial specialist referral among patients with endometriosis. MATERIAL AND METHODS: Patients were identified as having endometriosis intraoperatively based on International Classification of Diseases coding. Operation reports were reviewed and graded for severity of disease. This cohort was then retrospectively audited to identify reasons for initial referral to the general gynaecology, endosurgery, gynae-oncology, reproductive medicine outpatient departments (OPD) at the Mercy Hospital for Women in Melbourne between 1 February 2015 and 31 December 2016. RESULTS: Three hundred patients were identified as having endometriosis at laparoscopy, including 90 women with Stage IV disease. Patients were a mean (SD) age of 33.1 (7.6) years. While pain remained a common reason for referral (61.7% of referrals), 36.7% of women with Grade IV disease did not have pain included in their referral letter. Severe disease was associated with increased age (regression coefficient 0.05; 95% CI: 0.03-0.07, P < 0.01), but not with pain symptoms. Women referred with ovarian cysts or masses were more likely to be diagnosed with severe disease (regression coefficient 0.69; 95% CI: 0.37-1.01, P < 0.01). CONCLUSION: Although pelvic pain is not a good predictor for a diagnosis of endometriosis, it remains a common symptom among women with the disease. However, more than one in three patients with Grade IV endometriosis presented without mention of pain symptoms, encouraging clinicians to adopt a broader approach to the presenting symptoms of endometriosis.

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Condition tags

mesh:D004715mesh:D017699endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Pelvic Pain Pelvic Pain Adult Australia Australia Female Humans Laparoscopy Retrospective Studies

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (32)

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