Reiser Elisabeth, Göbel Georg, Perricos-Hess Alexandra, Buchweitz Olaf, Jaekel Matthias, Westphal Elisa, Rimbach Stefan, Woelfler Monika, Kraemer Bernhard, Kolben Thomas, Pempelfort Sara Dunja, Pashkunova Daria, Metzler Julian, Derihaci Razvan Petru, Klein Petra, Janschek Elisabeth, Guttenberg Philipp, Wuester Mathis, Wolfrum Angelika, Seifert-Klauss Vanadin, Enzelsberger Simon-Hermann, Keckstein Joerg, Wenzl Rene, Seeber Beata
Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Institute of Clinical Epidemiology, Public Health, Health Economics, Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria.
Hum Reprod. 2025 Sep 1;40(9):1643-1650. doi: 10.1093/humrep/deaf120.
Is there an association between pre-operative symptoms and intraoperatively described localization and size of endometriosis lesions as assessed by the #ENZIAN classification system?
Dyschezia is associated with any deep infiltrating endometriosis (DE) lesions; severe dyspareunia is associated with adenomyosis.
Previous attempts to correlate the common symptoms of endometriosis to the size and localization of lesions have been of moderate success.
STUDY DESIGN, SIZE, DURATION: This prospective, multicentre, non-interventional cross-sectional study was conducted between September 2022 and January 2024 at 18 endometriosis centres in Austria, Germany, and Switzerland, enrolling a total of 838 patients with endometriosis.
PARTICIPANTS/MATERIALS, SETTING, METHODS: The study included 521 patients with complete information on pre-operative symptoms and intraoperatively diagnosed endometriosis classified by the #ENZIAN classification system. Associations between symptoms and localization of endometriosis lesions were analysed.
Nearly all patients (n = 513) (98.5%) suffered from dysmenorrhea whereas 294 (56.4%), 208 (39.9%), and 102 (19.6%) patients reported dyspareunia, dyschezia, and dysuria, respectively. Dyspareunia rated as ≥8 on a visual analogue scale was reported 3.5-fold more often in patients with adenomyosis only (OR 3.56 [1.38-9.17]) than in those without, while dyschezia was almost twice as likely in those with any form of DE (OR 1.86 [1.3-2.65]).
LIMITATIONS, REASONS FOR CAUTION: A larger study population is needed to clinically define relevant sub-groups based on localization of lesions.
The findings of the present study identify adenomyosis as a strong driver of pain, especially dyspareunia, making awareness of its high prevalence of utmost importance. Few direct associations between symptoms and lesions were identified. Endometriosis-related symptoms, especially when chronic, are multi-factorial and cannot be readily correlated to specific lesion sites.
STUDY FUNDING/COMPETING INTEREST(S): This study received no external funding and all the authors declare they have no conflicts of interest pertaining to this study.
Clinical Trials NCT05624567.
根据#ENZIAN分类系统评估，术前症状与术中描述的子宫内膜异位症病变的定位和大小之间是否存在关联？
排便困难与任何深部浸润性子宫内膜异位症（DE）病变相关；严重性交困难与子宫腺肌病相关。
此前将子宫内膜异位症的常见症状与病变大小和定位相关联的尝试取得了一定成功。
研究设计、规模、持续时间：这项前瞻性、多中心、非干预性横断面研究于2022年9月至2024年1月在奥地利、德国和瑞士的18个子宫内膜异位症中心进行，共纳入838例子宫内膜异位症患者。
研究对象/材料、研究环境、方法：该研究纳入了521例术前症状信息完整且术中经#ENZIAN分类系统诊断为子宫内膜异位症的患者。分析了症状与子宫内膜异位症病变定位之间的关联。
几乎所有患者（n = 513）（98.5%）患有痛经，而分别有294例（56.4%）、208例（39.9%）和102例（19.6%）患者报告有性交困难、排便困难和排尿困难。仅患有子宫腺肌病的患者中，视觉模拟量表评分≥8分的性交困难报告频率比无子宫腺肌病的患者高3.5倍（比值比3.56 [1.38 - 9.17]），而有任何形式DE的患者出现排便困难的可能性几乎是无DE患者的两倍（比值比1.86 [1.3 - 2.65]）。
局限性、谨慎原因：需要更大的研究人群来根据病变定位在临床上定义相关亚组。
本研究结果表明子宫腺肌病是疼痛尤其是性交困难的强烈驱动因素，认识到其高患病率至关重要。症状与病变之间几乎没有直接关联。与子宫内膜异位症相关的症状，尤其是慢性症状，是多因素的，无法轻易与特定病变部位相关联。
研究资金/利益冲突：本研究未接受外部资金，所有作者声明他们与本研究不存在利益冲突。
临床试验NCT05624567。
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