Clinical characteristics of endometriosis with and without dysmenorrhea diagnosed by laparoscopy

Yi Li, Yi-Fen Li, Wen-Wei Li, Wenwei Li, Xiao-Hui Yang, Xiaohui Yang, Yuebo Yang, Yue-Bo Yang, Qing-Jian Ye
Frontiers in medicine · 2025 · vol. 12 , pp. 1635960 · doi:10.3389/fmed.2025.1635960 · PMID:41020245 · PMC12462631 · W4414123144
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study of 489 endometriosis patients found that dysmenorrhea was present in 70.6% and associated with younger age, higher CA125, advanced surgical stage, infertility, and deep infiltrating nodules.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This retrospective study evaluated 489 laparoscopically diagnosed, pathologically confirmed endometriosis patients by comparing those with dysmenorrhea (n=345) versus those without (n=144), and then stratifying dysmenorrhea patients by pain severity (VAS categories) and pain duration (≤1 year to >10 years). Patients with dysmenorrhea were younger and had higher CA125 levels, higher rASRM surgical stage/scores, more deep infiltrating nodules, and higher infertility prevalence; elevated CA125 and infiltrating nodules were independent risk factors for dysmenorrhea, and CA125 and surgical staging increased with dysmenorrhea severity. Dysmenorrhea duration correlated positively with CA125 and surgical staging, with CA199 rising up to 5–10 years but decreasing in those with >10 years of symptoms, and longer dysmenorrhea duration was associated with a higher incidence of adenomyosis. A major limitation acknowledged by the design is that this is retrospective and based on symptom presence at diagnosis, with detailed duration data available only for 140 patients. This paper is centrally about endometriosis — specifically, it analyzes how the presence, severity, and duration of dysmenorrhea relate to endometriosis stage, biomarkers, infertility, and co-occurring adenomyosis.

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Abstract

OBJECTIVE: This study aimed to delineate the clinical characteristics of endometriosis patients with dysmenorrhea and analyze the correlations between the presence, severity, and duration of dysmenorrhea and the severity of endometriosis. METHODS: In this retrospective study, a total of 489 patients with endometriosis were enrolled who had undergone laparoscopic surgery or had been diagnosed with endometriosis during surgery for benign ovarian tumors. The patients were categorized into dysmenorrhea-positive and dysmenorrhea-negative groups based on the presence of symptoms at diagnosis. Subgroup analyses were further performed within the dysmenorrhea group based on pain severity (mild/moderate/severe) and duration (years). The impact of dysmenorrhea on endometriosis severity was evaluated using clinical, surgical, and histopathological parameters. RESULTS: The proportion of patients without dysmenorrhea was 29.4%, while the proportion of patients with dysmenorrhea was 70.6%. Patients with dysmenorrhea were found to be younger, had significantly higher CA125 levels, and had a higher surgical stage. Patients with dysmenorrhea were observed to be more likely to experience infertility and deep infiltrating nodules. Elevated CA125 levels and infiltrating nodules were found to be independent risk factors for dysmenorrhea. CA125 levels and surgical staging significantly increased with the severity of dysmenorrhea. CA199 levels increased with dysmenorrhea duration but decreased in patients with >10 years of symptoms. The longer the duration of dysmenorrhea, the more frequently adenomyosis was observed. CONCLUSION: The presence, severity, and prolonged duration of dysmenorrhea are strongly associated with advanced endometriosis, infertility, and adenomyosis. Young women with dysmenorrhea warrant heightened clinical suspicion for endometriosis to avoid delayed diagnosis.

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Outcome instruments

VAS-pain rASRM

Condition tags

endometriosisadenomyosisdysmenorrheainfertility

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