Background
Methods
Definition
Search engines
Search strategy
Inclusion and exclusion criteria
Data synthesis
Results
Descriptive findings
Review of overview papers
Author(s) [Ref.] | Year | Results for symptoms | Results for signs |
---|---|---|---|
Valle [14] | 2002 | Pelvic pain that often is worse just before and during menstruation, hypermenorrhea, premenstrual staining, dyspareunia, suprapubic pain, dysuria, hematuria, painful defecation (dyschezia), lower back pain. | Local tenderness in cul de sac or uterosacral ligaments, adnexal enlargement or tenderness, pelvic masses. |
Spaczynski and Duleba. [15] | 2003 | Chronic pelvic pain consists of dysmenorrhea, intermenstrual pain, and dyspareunia. | Bluish implants typical of endometriosis or red, hypertrophic lesions bleeding on contact, usually in the posterior fornix. lateral cervical displacement, cervical stenosis. Retroversion, decreased or absent mobility of uterus and tenderness. Tender masses, nodules, and fibrosis appreciated on palpation of the upper vagina, cul-de-sac, uterosacral ligaments, or rectovaginal septum. |
Kennedy et al. [16] | 2005 | Severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical or perimenstrual symptoms (e.g. bowel or bladder associated) with or without abnormal bleeding, infertility and chronic fatigue. | Pelvic tenderness, a fixed retroverted uterus, tender uterosacral ligaments or enlarged ovaries on examination. The diagnosis is more certain if deeply infiltrating nodules are found on the uterosacral ligaments or in the pouch of Douglas, and/or visible lesions are seen in the vagina or on the cervix. The findings may, however, be normal. |
Mounsey et al. [17] | 2006 | Pelvic pain, back pain, dyspareunia, dysmenorrhea loin pain, dyschezia, pain with micturition and infertility. | Tender nodules in the posterior vaginal fornix, uterine motion tenderness, a fixed and retroverted uterus, or tender adnexal masses. |
Denny and Mann. [18] | 2007 | Pain around menstruation, dyspareunia, dyschezia, cyclical dysuria and extreme fatigue. | Not discussed. |
Amer [19] | 2008 | Dysmenorrhoea, dyschezia, hematochezia, dysurea, haematurea, dyspareunia, chronic pelvic pain, heavy and/or irregular periods, premenstrual spotting, infertility. | Tenderness on cervical movement, thickening and tenderness of the uterosacral ligaments, fullness or mass in the pouch of Douglas (POD), fixation and retroversion of the uterus, rectovaginal nodule. Adnexal (or even a pelvi-abdominal) mass in women with large endometriomas. |
Luisi et al. [2] | 2009 | Severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical or perimenstrual symptoms with or without abnormal bleeding, infertility and chronic fatigue. | Not discussed. |
Giudice. [20] | 2010 | Chronic pelvic pain (lasting ≥6 months), dysmenorrhea, dyspareunia, deep pelvic pain, and lower abdominal pain with or without back and loin pain. The pain can be continuous, and it can be dull, throbbing, or sharp, and exacerbated by physical activity. Bladder- and bowel associated symptoms (nausea, distention, and early satiety) are typically cyclic. Burning or hypersensitivity symptoms that are suggestive of a neuropathic component (infrequently). | A pelvic mass, immobile pelvic organs, and rectovaginal nodules. |
Altman and Wolcyzk. [21] | 2010 | Chronic pelvic pain, dysmenorrhea, dyspareunia, infertility, back pain, dyschezia, rectal pain, diarrhea, constipation, dysuria, hematuria, infertility, chronic fatigue and psychosocial stressors. | Palpable tender nodules in the cul-de-sac or uterosacral ligaments; localized tenderness in the cul-desac, uterosacral ligaments, or rectovaginal septum; pain with uterine movement; enlarged or tender adnexal masses; and fixation of adnexa or uterus in a retroverted position. Red, blue, or hemorrhagic nodules may also be visualized on the external genitalia, vagina, or cervix. |
Okeke and Ikeako. [9] | 2011 | Dysmenorrhea, dyspareunia, menorrhagia and infertility. | Not discussed. |
Koninckx et al. [22] | 2012 | Hypogastric pain, especially dysmenorrhea, deep dyspareunia, severe chronic pain, mictalgia, and dyschezia. | Not discussed. |
Acién and Velasco [23] | 2013 | Dysmenorrhea (during and at the end of menstruation), deep dyspareunia, chronic pelvic pain, and infertility premenstrual spotting for 2–4 days, headache, irritability, or premenstrual tension syndrome. | Not discussed. |
Carneiro M M et al. [24] | 2013 | Dysmenorrhea, dyspareunia, dyschezia, gastrointestinal symptoms, chronic pelvic pain, infertility. | Pelvic tenderness, a fixed retroverted uterus, tender uterosacral ligaments or enlarged ovaries, uterosacral nodularity. |
Schrager et al. [25] | 2013 | Debilitating pelvic pain, dysmenorrhea, dyspareunia, and decreased fertility. | Not discussed. |
Mehedintu et al. [26] | 2014 | Severe dysmenorrhea, non-cyclical chronic pelvic pain, dysfunctional uterine bleeding, infertility, dyspareunia, painful defecation during menstruation, urinary tract symptoms and gastrointestinal symptoms | Not discussed. |
Bhattacharjee et al. [27] | 2014 | Dysmenorrhea, deep dyspareunia, infertility, abnormal uterine bleeding, non-cyclic pain, menstrual cycle abnormalities, constipation, chronic fatigue, heavy or long uncontrollable menstrual periods with small or large blood clots, gastrointestinal problems including diarrhea, bloating and painful defecation, extreme pain in legs and thighs, back pain, mild to extreme pain during intercourse, pain from adhesions which may bind an ovary to the side of the pelvic wall, or they may extend between the bladder and the bowel, uterus, extreme pain with or without the presence of menses, premenstrual spotting, mild to severe fever, headaches, depression, hypoglycemia and anxiety. | Non-specific pelvic tenderness, localized tenderness in the pouch of Douglas, thickened nodular uterosacral ligaments, fixed retroverted uterus, palpable fixed cystic adnexal mass or an obliterated pouch of Douglas, masses, fixity of organs, displacements of cervix & presence of nodules in the rectovaginal pouch or uterosacral ligaments, nodularity or tenderness in the uterosacral ligament, bluish or red powder burn lesions may be seen in the cervix or posterior fornix of the vagina (which may be tender or bleed on touch), bluish nodules in the posterior fornix, a fixed retroverted tender uterus or a firm fixed pouch of Douglas. |
Clinical diagnosis
Clinical diagnosis by symptoms obtained from history taking
Author(s) [Ref.] | Year | Study design | Sample size | Findings |
---|---|---|---|---|
Eskenazi et al. [8] | 2001 | Prospective study (study sample); retrospective record review (test sample). | 90 | Symptoms: Dysmenorrhea, pelvic pain, dyspareunia and infertility. |
Signs: Uterosacral ligament scarring, nodularity, or pain, nodularity or pain in the pouch of Douglas, vaginal endometriotic lesions, painful or fixed adnexal masses, and fixed uterus or pain on movement of uterus in pelvic examination. | ||||
Chapron et al. [28] | 2002 | Retrospective analysis | 160 | Signs: Endometriotic lesions seen in speculum examination and classic, painful, spheric nodule or painful induration in palpation. |
Ballweg L M [29] | 2004 | Cross sectional | 7000 | Symptoms: Fatigue, exhaustion, low energy, numerous gastrointestinal symptoms, abdominal bloating, diarrhea, painful bowel movements or other intestinal upset, nausea and stomach upset at time of period, a wide range of allergies and allergic disease; heavy or irregular bleeding, pain with or after sex, dizziness and headaches at the time of the period and other debilitating symptoms (unable to carry on normal activities, including work or school), in addition to the classic symptom of pain (dysmenorrhea, pain with or after sex (dyspareunia). Lower back pain, pain in the rectum, irregular bleeding, low resistance to infection, infertility, premenstrual spotting, low-grade fever, Pain related to urination, candidiasis, mid cycle bleeding, mitral valve prolapse. |
Lemaire. [11] | 2004 | Descriptive, cross-sectional correlational study. | 298 | Symptoms: Menstrual cramping, fatigue, lower back pain, heavy menstrual flow, non-period pelvic pain, diarrhea with period, allergy, urinary frequency, pain with intercourse, depressed feelings, constipation, muscle/bone pain, headache, anxious feelings, joint pain, leg pain, spotting between/before periods, rectal pain, urinary infection, yeast infection. |
Cheewadhanaraks et al. [30] | 2004 | Prospective study | 116 | Signs: Tenderness and/or nodularity of the cul-de-sac and/or uterosacral ligament(s). |
Chapron et al. [31] | 2005 | Cross sectional | 134 | Symptoms: Painful defecation during menses, severe dyspareunia, pain other than noncyclic, and previous surgery for endometriosis. |
Ballard and Mangubat. [32] | 2007 | National community-based case–control | 27715 | Symptoms: Pelvic pain and dysmenorrhea, dyspareunia, menorrhagia, urinary symptoms (dysuria, cystitis, and urinary tract infections), irritable bowel syndrome (IBS), pelvic inflammatory disease and ovarian cysts. |
Flores et al. [33] | 2008 | Cross sectional | 1285 | Symptoms: Dysmenorrhea, dyspareunia, conceiving problems, chronic pelvic pain, ovarian cysts, migraines, and gynecological infections. |
Greene et al. [34] | 2009 | Cross-sectional | 4334 | Symptoms: Pelvic pain, menstrual pain, ovulatory and nonmenstrual pain, lifetime presence of all three pain types, heavy bleeding, infertility, bowel symptoms, urinary symptoms, pain with urination, nausea/stomach upset or dizziness/headache during menses. |
Ballard et al. [35] | 2010 | Prospective questionnaire-based | 185 | Symptoms: Throbbing pain and dyschezia. |
Abbas et al. [7] | 2012 | Cohort | 62,323 | Symptoms: Dysmenorrhea, dyspareunia, intermenstrual pain, menorrhagia, ovarian cysts, pelvic pain, postcoital bleeding, infertility, irritable bowel syndrome, pelvic inflammatory disease. |
Nnoaham et al. [36] | 2012 | Prospective, observational, two-phase study | 1,396 | Symptoms: Dysmenorrhea, dyspareunia, pelvic pain, Bowel/urinary symptoms, infertility, family history. |
Hadisaputra. [37] | 2013 | Cross sectional | 80 | Symptoms: Infertility, dysmenorrhea, dyspareunia and chronic pelvic pain. Signs: Rectovaginal nodule and cervical tenderness. |
Cavaggioni et al. [47] | 2014 | Case- control | 80 | Symptoms: Mood and anxiety disorders, obsessive-compulsive malfunction, depression, alexithymia. |
Heitmann et al. [51] | 2014 | Retrospective cohort study | 80 | Symptom: Premenstrual spotting of ≥ _2 days |
Walch et al. [52] | 2014 | Prospective, controlled clinical trial | 102 | Symptom: Cyclic leg pain |
Barbosa et al. [53] | 2014 | Cross sectional | 387 | Symptom: Dysmenorrhea was the only clinical symptom |
Clinical diagnosis by signs obtained from physical examination
Clinical diagnosis by risk factors obtained from history taking
Author(s) [Ref.] | Year | Study design | Sample size | Findings |
---|---|---|---|---|
Kashima et al. [38] | 2004 | Case–control | 623 | Familial tendency. |
Hediger et al. [39] | 2005 | Cohort study | 48 | Taller, thinner and lower body mass index, late maturers (menarche at ≥14 y) and late to initiate sexual activity (≥21 y), less likely to be gravid, parous, and a current smoker. |
Flores et al. [33] | 2008 | Cross-sectional | 1285 | Longer length of menses, earlier menarche and shorter cycle length. |
Parazzini et al. [40] | 2008 | Case–control | 672 | More education, lower body mass index, never smoking and null parity. |
Sinaii et al. [41] | 2008 | Cross-sectional | 940 | Pelvic pain, subfertility. |
Yi et al. [1] | 2009 | Retrospective review of clinical records | 481 | Lower BMI. |
Bazot et al. [42] | 2009 | Retrospective longitudinal study | 92 | Infertility, previous surgery for endometriosis, nulliparity, noncyclic chronic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, dysuria and asthenia. |
Treloar et al. [12] | 2010 | Case–control | 268 | Early menarche and early history of dysmenorrhea. |
Lafay et al. [43] | 2011 | Case–control | 476 | Lower body mass index. |
Chapron et al. [44] | 2011 | Cross-sectional | 229 | Positive family history, more absenteeism from school during menstruation, OC pill use for treating severe primary dysmenorrhea. |
Nnoaham et al. [54] | 2012 | Systematic review and meta-analysis of case–control studies. | 18 articles | Early menarche |
Peterson et al. [45] | 2013 | Cohort | 626 | Infertility history, dysmenorrhea and pelvic pain. |
Parazzini et al. [55] | 2013 | Metaanalysis | 15 articles | Alcohol consumption |
Borghese et al. [46] | 2014 | cross-sectional | 663 | Rhesus negativity |
Xie et al. [48] | 2014 | prospective cohort study | 88 623 | Severe teenage acne. |
Vercellini et al. [49] | 2014 | Case–control | 771 | Blue eye color |
Tu et al. [50] | 2014 | Prospective cohort study | 9,585 | Prior OCP use in nulliparous women |
Bungum et al. [56] | 2014 | Systematic review | 5 articles | Increased risk of allergic disorders (asthma, hay fever/allergic rhinitis of the sinus, eczema, food allergy, allergy to either pollen, dust, trees, paint, grasses, cigarette smoke, perfumes/fragrances, cleaning products, foods or environmental chemicals) |
Bonocher et al. [57] | 2014 | Systematic review | 6 articles | Inconclusiveness regarding the benefits of physical exercise as a risk factor |