Diagnosis of pelvic endometriosis: A systematic review and accuracy meta-analysis of non-invasive tests available in primary care

Thomas Bainton, Sobanakumari Jeyapala, Javier Zamora, Khalid S. Khan, Amer Raza
In: F1000Research · 2023 · vol. 12 , pp. 453 · doi:10.12688/f1000research.131729.1 · W4367311841
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This systematic review and meta-analysis of 125 studies found that dysmenorrhea, pelvic pain, dyschezia, dyspareunia, family history, nulligravidity, TVUSS findings, and elevated CA-125 are predictive of endometriosis.

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

This paper is a systematic review and diagnostic accuracy meta-analysis of non-invasive tests for diagnosing pelvic endometriosis in primary care settings, synthesizing evidence across available tests and their performance metrics. The key finding is that across included studies, diagnostic accuracy varies by test and study design, and the pooled estimates reflect substantial heterogeneity rather than a single consistently reliable non-invasive approach. A major caveat is that limitations in the underlying evidence base—such as differences in test type, patient selection, reference standards, and study quality—constrain the certainty of conclusions. Relevance to endometriosis: this paper is directly focused on diagnostic accuracy for pelvic endometriosis using non-invasive tests suitable for primary care, and it therefore addresses endometriosis diagnosis.

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Abstract

Background: Endometriosis is a chronic, often debilitating condition with a current significant delay from symptom onset to diagnosis with much of this in primary care. Methods: A systematic review and meta-analysis of the primary literature was conducted to investigate the accuracy of symptoms, clinical history and first-line non-invasive tests to predict pelvic endometriosis (PROSPERO: CRD42020187543). We searched Medline, Embase, Web of Science and Scopus from conception (1966; 1972; 1997; 2004 respectively) to September 2022 for primary test accuracy studies assessing non-invasive tests against reference standard diagnosis for endometriosis. Two authors independently conducted data extraction and quality assessment. Grading of evidence was performed using a novel visual pentagon model. Meta-analyses of test accuracy was estimated using bivariate random effects models. Results: The 125 included studies (250,574 participants) showed mixed quality. Studies applying non-surgical (database/self-reporting) reference standard had a greater risk of bias. In 98 studies applying surgical reference standard, summary diagnostic odds ratios for endometriosis were: dysmenorrhoea 2.56 (95% confidence interval 1.99-3.29); pelvic pain 2.56 (1.73-3.74); dyschezia 2.05 (1.36-3.10); dyspareunia 2.45 (1.71-3.52); family history of endometriosis 6.79 (4.08-11.3); nulligravidity of 2.01 (1.62-2.50); body mass index (BMI) ≥30kg/m 2 0.37 (0.19-0.68); trans-vaginal ultrasound scan (TVUSS) endometrioma 91.2 (44.0-189); TVUSS invasive endometriosis 26.1 (9.28-73.5); and cancer antigen-125 (CA-125) >35U/mL 16.0 (8.09-31.7). Sensitivity analysis excluding all high-risk studies found concordant results. Conclusions: This meta-analysis collated the performance of non-invasive tests for endometriosis across a comprehensive and geographically varied population. Study quality was mixed, however results were consistent with high-risk studies excluded. These findings will inform future prediction models for triage in primary care.

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Condition tags

endometriosisendometriomadysmenorrheadyspareunia

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 (55)

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