Is Endometriosis Staging Related to the Type and Intensity of Patients' Complaints? A Systematic Review and Meta-Analysis

João Alves, João Sequeira Alves, Tânia Meneses, Meneses T, Mariano M, Marina Rufino Mariano, Mafalda Mariano, Serra SS, Sofia Silvério Serra, Sofia Serra, Teresa Costa, Martins JP, João Paulo Martins, Rabishong B, B. Rabishong, Benoit Rabishong, Jorge Lima
Journal of minimally invasive gynecology · 2025 · vol. 33(5) , pp. 505–515 · doi:10.1016/j.jmig.2025.11.014 · PMID:41338448 · W4416843604
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This systematic review and meta-analysis investigated whether the stage of endometriosis correlates with the type and intensity of symptoms experienced by patients.

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Abstract

OBJECTIVE: To evaluate the association between the endometriosis staging and the type and intensity of pain reported by patients, describing the pain intensity across different pain types. DATA SOURCES: On January 27, 2025, a systematic search was conducted in PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library. The search terms included endometriosis, pain, dysmenorrhea, dyspareunia, pelvic pain, dyschezia, dysuria, and classification. METHODS OF STUDY SELECTION: Eligible studies examined women with endometriosis, assessing how endometriosis staging (rASRM or ENZIAN classification) correlated with pain symptoms (dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain) measured with validated tools. TABULATION, INTEGRATION, AND RESULTS: Two reviewers extracted data independently, with a third verifying results. Pain scores were log-transformed to stabilize variance, and proportions of women with advanced endometriosis were analyzed on the logit scale. Given high heterogeneity, random-effects models with restricted maximum likelihood were used. Of 2527 records, 112 studies were reviewed and eight met inclusion criteria (seven using rASRM, one using ENZIAN). Dysmenorrhea showed the highest mean intensity (6.61, 95% CI: 4.43-10.10), while dysuria was lowest (1.08, 95% CI: 0.62-1.89). Pain intensity did not differ significantly between rASRM stages I/II and III/IV (p > 0.05), though chronic pelvic pain was more frequent in advanced disease (p < 0.05). CONCLUSION: Dysmenorrhea is linked to higher pain intensity in women with endometriosis, while dysuria is linked to lower intensity. Pain intensity is not associated with the rASRM stage; however, chronic pelvic pain seems more prevalent in advanced stages of the disease.

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Condition tags

dysmenorrheadyspareuniaendometriosischronic_pelvic_pain

MeSH descriptors

Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea

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 (49)

Cited by (2)

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