PREMENSTRUAL SPOTTING OF ≥2 DAYS

IS STRONGLY ASSOCIATED WITH

HISTOLOGICALLY CONFIRMED
ENDOMETRIOSIS IN WOMEN WITH
INFERTILITY
Dibuat oleh : Beatrice Sukidy
Perseptor : dr. Julita D.L. Nainggolan, Sp.OG
INTRODUCTION

• Endometriosis is a debilitating gynecologic condition classically defined as the presence of

endometrial glands and stroma in ectopic locations.
• Affecting 6-10% reproductive-aged women, associated with pain and infertility.
• Diagnosis : visual inspection of abdomen and pelvis with histologic confirmation of
biopsied lesions.
• Laparoscopy : relatively safe but poses surgical risk and expensive.
• To date : an accurate, noninvasive diagnostic test for endometriosis is still unavailable.
MATERIAL AND METHODS

• A retrospective cohort study • Medical records : prensence and duration

• Laparoscopy and biopsy : of premenstrual spotting, dysmenorrhea,
dyspareunia.
- The extent of endometriosis : staged
• Sample : - 80 consecutive women who
using the revised American Fertility underwent laparoscopy for infertility
Society (rAFS) classification system. with/without pelvic pain from March 2009
– March 2011 that met inclusion criteria.
- Peritoneal implants : red vesicular/power
- Reproductive age, regular menses and least
burn phenotype.
unilateral tubal patency.
MATERIALS AND METHODS

• Methods :
- Age, gravidity, parity and BMI were compared using t test
- The association between endometriosis and premenstrual spotting were compared using chi
square.
- Each variable (premenstrual spotting, dysmenorrhea, dyspareunia, dyschezia, age, parity,
and bmi) and each outcome (endometriosis, rAFS stage, lesional phenotype) were indicated by
the phi-coefficient.
- The variability between self-reported premenstrual spotting and histologic findings was performed
with unweighted kappa analysis
- Statistical analysis was performed using SPSS software.
RESULTS

• 80 consecutive women who met

inclusion criteria
→ 38 women reported premenstrual
spotting of ≥2 days and 42 women denied
premenstrual spotting on both intake
questionnaire and during menstrual history.
RESULTS
RESULTS
RESULTS
DISCUSSION

• There is a strong association between premenstrual spotting ≥ 2 days and the finding of
endometriosis at surgery in woman with infertility.
• Particularly advanced-stage disease (rAFS, >stage1) and the red vesicular lesion
phenotype (produce higher PGF2α than typical powder-burn implants).
• Pathophysiology : red vesicular lesion → produce high prostaglandin F (PGF2α) → exert
a luteolytic effect on the corpus luteum in the absence of pregnancy → low progesterone
→ premenstrual spotting.
DISCUSSION

• Study advantages : • Study limitations :

o The use of histologic confirmation o Retrospective design.
(the pathologist was blinded to the o Pelvic pain did not included in the
patient’s premenstrual status). study criteria.
o The stage of disease and the type of
peritoneal endometriotic lesion
were observed.
THANK YOU