Dyspareunia and heavy menstrual bleeding as clinical predictors of concomitant endometriosis in Inflammatory Bowel Disease: A multidisciplinary prospective study

Benedetto Neri, Neri B, Mariasofia Fiorillo, Fiorillo M, Iacobini F, Federica Iacobini, Roberto Mancone, Mancone R, Balice R, Raffaele Balice, Eleonora Laluci, Laluci E, Francesca Fabrizi, Fabrizi F, Michele Lucarelli, Lucarelli M, Russo C, Consuelo Russo, Exacoustos C, C. Exacoustós, Caterina Exacoustos, Biancone L, Livia Biancone
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver · 2026 · vol. 58(10) , pp. 1266–1273 · doi:10.1016/j.dld.2026.07.086 · PMID:42637594 · W7204196895
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Multivariate analysis identified dyspareunia and heavy menstrual bleeding as significant risk factors for concomitant endometriosis, particularly deep infiltrating disease, in fertile patients with inflammatory bowel disease.

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Abstract

BACKGROUND: The association between Inflammatory Bowel Disease (IBD) and endometriosis is undefined. AIMS: The primary aim was to identify clinical predictors of endometriosis in IBD. Secondary aim was to compare symptoms and IBD characteristics in patients with versus without endometriosis. METHODS: Consecutive fertile IBD patients with ≥1 symptom compatible with endometriosis were prospectively enrolled. Pelvic endometriosis was searched by transvaginal ultrasonography (TVUS). RESULTS: The study population included 82 IBD patients (age: 38 [18-53] years): 41 (50%) Crohn's Disease (CD), 41 (50%) Ulcerative Colitis (UC). Symptoms included: dysmenorrhea (n=72 [87.8%]), dyschezia (n=29 [35.4%]), dyspareunia (n=46 [56.1%]), heavy menstrual bleeding (HMB) (n=50 [60.9%]), chronic abdominal pain (n=22 [26.8%]). TVUS detected endometriosis in 51 (62.2%) patients (CD: 23 [45.1%], UC: 28 [54.9%]), including deep infiltrating endometriosis (DIE) in 44 (86.3%). Dyspareunia, HBM and chronic abdominal pain were more frequent in patients with endometriosis (35 [68.6%] vs 11 [35.5%], p=0.007; 36 [70.6%] vs 14 [45.2], p=0.03; 18 [35.3%] vs 4 [12.9%], p=0.04). Multivariate analysis identifyied dyspareunia and HMB as risk factors for endometriosis (4.7 [1.6-13.9]; p=0.005; 4.3 [1.4-12.9]; p=0.008). CONCLUSIONS: Endometriosis may be highly underestimated in IBD, being mostly represented by DIE. Dyspareunia and HMB should be carefully searched in fertile young IBD patients to roule out an undiagnosed endometriosis.

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MeSH descriptors

Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative Colitis, Ulcerative

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References (29)

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