Is Endometriosis Staging Related to the Type and Intensity of Patients' Complaints? A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 41338448 · doi:10.1016/j.jmig.2025.11.014
What was done
Systematic review and meta-analysis searching PubMed, Scopus, Web of Science, EMBASE, and Cochrane Library through January 2025. Included studies evaluated correlations between endometriosis staging systems (rASRM or ENZIAN) and pain symptoms (dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain) assessed via validated tools. Pain scores were log-transformed and pooled using random-effects models with restricted maximum likelihood.
What was found
From 2,527 initial records, 8 studies met inclusion criteria (7 using rASRM and 1 using ENZIAN). Dysmenorrhea showed the highest pooled mean pain intensity (6.61, 95% CI: 4.43–10.10), whereas dysuria showed the 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). However, chronic pelvic pain was significantly more frequent in advanced disease stages (p < 0.05).
Why it matters
Confirms that anatomical staging systems like rASRM correlate poorly with subjective pain intensity, meaning surgical severity does not predict symptom severity for patients.
Limits
Only 8 studies were eligible, with only a single study evaluating the ENZIAN classification system. High heterogeneity was noted across included studies. Total patient sample size and specific risk-of-bias parameters are not provided in the abstract.
Cited by
- supports The surgical or anatomical stage of endometriosis does not correlate with the severity of pelvic pain experienced by the patient.