Endometriosis-associated dysmenorrhea is not related to typical or atypical peritoneal implants

From April 1, 1995, to December 31, 1995, 45 patients undergoing diagnostic or operative laparoscopy for infertility, pelvic pain, or both, were found to have endometriosis. No woman had undergone any preoperative medical or surgical treatment for the disease. Preoperatively they answered a questionnaire, including a visual analog scale (VAS) to evaluate their associated symptoms. All visible signs of endometriosis were evaluated at laparoscopy by a single observer and recorded. Endometriosis was classified as cysts, adhesions, typical implants (black-blue powder burn implants), and atypical implants (clear papules, red polyps, flamelike lesions, red-brown vesicles, white opacification, peritoneal defects). The revised American Fertility Society (AFS) score was also used to stage the disease. The VAS scale for dysmenorrhea correlated significantly with the AFS total score (Pearson's r = 0.510, p <0.001), the cyst subscore (r = 0.490, p <0.001), and the adhesion subscore (r = 0.381, p <0.01). There was no correlation between the VAS scale for dysmenorrhea and the AFS implant subscore (r = 0.019), or with the total number of endometriosis implants (r = 0.160), the number of typical implants (r = 0.025), or the number of atypical implants (r = 0.161). The AFS score for endometriosis, devised primarily to formulate a prognosis in infertile women, seems to be correlated also with endometriosis-associated dysmenorrhea. Although atypical implants produce higher amounts of prostaglandin F2alpha compared with typical implants, the present study does not support the suggested association between them and the severity of dysmenorrhea.