Association of platelets and platelet-related parameters (PLT/MPV/PLR) in endometriosis: a meta-analysis

Jincheng Qiu, Qiu J, Li J, Jiayi Li, J J Li, Anya Wang, Wang A, Kaiqing Lin, Lin K
BMC women's health · 2026 · vol. 26(1) · doi:10.1186/s12905-026-04630-9 · PMID:42380851 · PMC13584367 · W7166672781
Systematic review / meta-analysis OA: gold CC0
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This meta-analysis found mean platelet volume (MPV) significantly elevated in endometriosis patients compared to controls, while platelet count (PLT) and platelet-to-lymphocyte ratio (PLR) showed variable associations depending on the control group.

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This meta-analysis evaluated the diagnostic potential of platelet count, mean platelet volume, and platelet-to-lymphocyte ratio in patients with endometriosis by synthesizing data from nineteen studies involving 5,675 subjects. The pooled results indicated that while overall differences in platelet count and platelet-to-lymphocyte ratio were not statistically significant compared to non-endometriosis populations, mean platelet volume was significantly elevated in those with the condition. Subgroup analyses revealed that these markers showed context-dependent associations, such as higher platelet counts when comparing endometriosis to other benign gynecological conditions but lower counts relative to ovarian cancer. This paper is centrally about endometriosis — specifically investigating hematological biomarkers for its diagnosis.

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Abstract

BACKGROUND: Endometriosis (EMS) is a prevalent gynecological condition, and its diagnosis remains challenging. Hematological indicators such as platelet count (PLT), mean platelet volume (MPV), and platelet-to-lymphocyte ratio (PLR) have recently received attention for their potential diagnostic value in EMS. OBJECTIVE: To assess the association of PLT, MPV, and PLR in EMS by a meta-analysis. METHODS: We systematically searched Embase, PubMed, Cochrane Library, and Web of Science up to June 2025 for studies on the association of platelet-related parameters (PLT, MPV, and PLR) with EMS. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for PLT, MPV, and PLR using a random-effects model. All statistical analyses were performed using Stata16.0. RESULTS: Nineteen studies with 5675 subjects were included. Overall pooled analyses showed no statistically significant differences in PLT (SMD 0.35 [- 0.02, 0.71], I²=97.6%, P = 0.063) and PLR (SMD 0.24 [- 0.16, 0.64], I²=96.6%, P = 0.224) between EMS and non-EMS populations. However, MPV was significantly elevated in EMS compared with non-EMS populations (SMD 0.30 [0.09, 0.52], I²=82.7%, P = 0.006). Subgroup analyses by control group type revealed context-dependent associations. Compared with benign gynecological conditions (e.g., ovarian cysts, uterine fibroids), EMS showed significantly elevated PLT (SMD 0.20 [0.01, 0.38], I²=53.7%, P = 0.042) and PLR (SMD 0.33 [0.22, 0.43], I²=0.0%, P < 0.01). PLT was significantly lower in EMS than in ovarian cancer (SMD - 0.56 [- 0.81, - 0.32], I²=0.0%, P < 0.001). MPV was significantly elevated in EMS compared with healthy individuals (SMD 0.46 [0.11, 0.81], I²=84.7%, P = 0.010), whereas no significant difference was observed between EMS and other benign gynecological conditions (SMD 0.04 [- 0.10, 0.19], I²=0.0%, P = 0.547). CONCLUSION: MPV shows potential as an adjunctive marker for EMS, while PLT and PLR have limited independent diagnostic value but may be useful in specific clinical contexts.
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Abstract

Background Endometriosis (EMS) is a prevalent gynecological condition, and its diagnosis remains challenging. Hematological indicators such as platelet count (PLT), mean platelet volume (MPV), and platelet-to-lymphocyte ratio (PLR) have recently received attention for their potential diagnostic value in EMS.

Objective

To assess the association of PLT, MPV, and PLR in EMS by a meta-analysis.

Methods

We systematically searched Embase, PubMed, Cochrane Library, and Web of Science up to June 2025 for studies on the association of platelet-related parameters (PLT, MPV, and PLR) with EMS. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for PLT, MPV, and PLR using a random-effects model. All statistical analyses were performed using Stata16.0.

Results

Nineteen studies with 5675 subjects were included. Overall pooled analyses showed no statistically significant differences in PLT (SMD 0.35 [− 0.02, 0.71], I²=97.6%, P = 0.063) and PLR (SMD 0.24 [− 0.16, 0.64], I²=96.6%, P = 0.224) between EMS and non-EMS populations. However, MPV was significantly elevated in EMS compared with non-EMS populations (SMD 0.30 [0.09, 0.52], I²=82.7%, P = 0.006). Subgroup analyses by control group type revealed context-dependent associations. Compared with benign gynecological conditions (e.g., ovarian cysts, uterine fibroids), EMS showed significantly elevated PLT (SMD 0.20 [0.01, 0.38], I²=53.7%, P = 0.042) and PLR (SMD 0.33 [0.22, 0.43], I²=0.0%, P < 0.01). PLT was significantly lower in EMS than in ovarian cancer (SMD − 0.56 [− 0.81, − 0.32], I²=0.0%, P < 0.001). MPV was significantly elevated in EMS compared with healthy individuals (SMD 0.46 [0.11, 0.81], I²=84.7%, P = 0.010), whereas no significant difference was observed between EMS and other benign gynecological conditions (SMD 0.04 [− 0.10, 0.19], I²=0.0%, P = 0.547).

Conclusion

MPV shows potential as an adjunctive marker for EMS, while PLT and PLR have limited independent diagnostic value but may be useful in specific clinical contexts. Similar content being viewed by others Abbreviations - EMS: - Endometriosis - PLT: - Platelet count - MPV: - Mean platelet volume - PLR: - Platelet-to-lymphocyte ratio - SMD: - Standardized mean difference - NOS: - Newcastle-Ottawa Scale

Acknowledgements

Not applicable. Funding The authors declare that they did not receive any funding from any source. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Qiu, J., Li, J., Wang, A. et al. Association of platelets and platelet-related parameters (PLT/MPV/PLR) in endometriosis: a meta-analysis. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04630-9 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04630-9

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Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets Blood Platelets

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