Heitmann, R. J., Langan, K. L., Huang, R. R., Chow, G. E., & Burney, R. O. (2014). Premenstrual spotting of ≥2 days is strongly associated with histologically confirmed endometriosis in women with infertility. American Journal of Obstetrics and Gynecology, 211(4), 358.e1-358.e6. https://doi.org/10.1016/j.ajog.2014.04.041
Heitmann RJ, Langan KL, Huang RR, Chow GE, Burney RO. Premenstrual spotting of ≥2 days is strongly associated with histologically confirmed endometriosis in women with infertility. Am J Obstet Gynecol. 2014;211(4):358.e1-358.e6. doi:10.1016/j.ajog.2014.04.041
Heitmann, Ryan J., et al. "Premenstrual spotting of ≥2 days is strongly associated with histologically confirmed endometriosis in women with infertility." American Journal of Obstetrics and Gynecology, vol. 211, no. 4, 2014, pp. 358.e1-358.e6.
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Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Madigan Healthcare System, Tacoma, WA; Department of Clinical Investigation, Madigan Healthcare Syst...01sfyq865
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RRM Academy Synopsis
Premenstrual spotting of 2+ days predicts endometriosis in infertility
The study reviewed 80 women who had laparoscopy for infertility at one center. In this group, 89 out of 100 women with premenstrual spotting of 2 days or more had confirmed endometriosis. Among women without spotting, 26 out of 100 did.
Key Findings
Endometriosis was histologically confirmed in 34 of 38 women (89%) with premenstrual spotting for at least 2 days and in 11 of 42 women (26%) without it (P < .0001).
Among the 34 women with spotting and endometriosis, 29 (85%) had disease beyond stage I. All 11 cases in women without spotting were stage I.
In these 80 women, spotting of at least 2 days correctly classified 81%, compared with 76% for painful periods (dysmenorrhea) and 58% for pain with intercourse (dyspareunia).
After adjustment, spotting for at least 2 days had an odds ratio of 16 (95% CI, 3.9-65.4) for endometriosis and 52.6 (95% CI, 8.6-323.1) for red vesicular lesions.
Interpretation
This study followed 80 women who had surgery for infertility at one center. Spotting of 2 or more days found endometriosis better than painful periods or painful sex did. Spotting was also linked with more advanced disease. The results support larger studies of spotting as a sign of endometriosis.
RRM Context
Fertility awareness charting tracks bleeding patterns day by day. Restorative reproductive medicine treats those patterns as clinical information. The authors think red spots on the pelvic lining may cause spotting by shortening the womb lining's hormone support. They tested that idea in this study. The paper notes a 6.7-year average wait from first symptoms to diagnosis.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
The purpose of this study was to assess the prevalence of endometriosis in women with premenstrual spotting and to determine the predictive value of this symptom in the diagnosis of endometriosis.
Study Design
We conducted a retrospective cohort study of 80 consecutive women who presented to the infertility clinic for evaluation and who subsequently underwent laparoscopic assessment for infertility with or without pelvic pain. Our main outcome measure was the presence or absence of histologically confirmed endometriosis in women with and without premenstrual spotting.
Results
Endometriosis was significantly more prevalent in subfertile women who reported premenstrual spotting for ≥2 days relative to women without this symptom (89% [34/38 women] vs 26% [11/42 women]; P < .0001). Multinomial logistic regression analysis demonstrated the presence of premenstrual spotting for ≥2 days to be associated significantly with the presence of endometriosis (odds ratio, 16; 95% confidence interval, 3.9-65.4; P < .01) and red vesicular lesion type (odds ratio, 52.6; 95% confidence interval, 8.6-323.1; P < .001).
Conclusion
In this cohort of women with infertility, premenstrual spotting of ≥2 days was associated strongly with histologically confirmed endometriosis and a better predictor than dysmenorrhea or dyspareunia of finding endometriosis at laparoscopy. Premenstrual spotting of at least 2 days was also associated strongly with both higher stage disease and the red vesicular peritoneal endometriosis phenotype.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
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