Accuracy of Clinical Signs and Symptoms in the Diagnosis of Endometriosis

Abstract

Endometriosis is a benign gynecological disease afffecting about 10% of all reproductive-age women which can significantly impair quality of life. As the clinical presentation is variable, with some women experiencing several severe symptoms while others remain asymptomatic, there are no sufficiently sensitive and specific signs and symptoms or diagnostic tests for the clinical diagnosis of endometriosis. The aim of this article is to review the current literature regarding the accuracy of clinical signs and symptoms in the diagnosis of endometriosis. Besides the wide spectrum of symptoms, an overlap with other causes of pelvic pain such as irritable bowel syndrome and pelvic inflammatory disease is also reported. Moreover, most of the signs and symptoms of endometriosis do not correlate with the severity (staging) of the disease. Knowledge of the characteristics of pelvic pain symptoms is important in the preoperative assessment of patients with suspected endometriosis. Pelvic tenderness, a fixed retroverted uterus, tender uterosacral ligaments or enlarged ovaries identified during a standard pelvic exam are suggestive of endometriosis. Clinical examination during menstruation apparently improves diagnostic yield. Although the clinical diagnosis of endometriosis presents low sensitivity and specificity, it should be thoroughly performed as it is the first fundamental step in the diagnostic workup. Clinical assessment helps to identify patients at high risk of endometriosis and selects those who need further testing in order to reduce diagnostic delay. Laparoscopy preferably performed in conjunction with histologic evaluation of excised lesions, however, still remains the gold standard for diagnosis as well as staging of endometriosis.