Diagnosis of deep endometriosis by clinical examination during menstruation and plasma CA-125 concentration
Open accessAbstract
Objectives To evaluate a clinical examination during menstruation and plasma CA-125 concentrations to diagnose deep endometriosis.Design Prospective study in 61 women scheduled for a laparoscopy, a retrospective study in 140 women with deep endometriosis, and a clinical validation study in 16 women with painful pelvic nodularities during menstruation.Setting University Hospital Gasthuisberg, a tertiary referral center.Results In the retrospective study, deep endometriosis was detected by routine clinical examination in only 36% of women. Lesions infiltrating deeper than 15 mm were detected in 50%. In the prospective study pelvic nodularities were detected by routine clinical examination in 4 women but were detected in 22 by clinical examination during menstruation. The latter was highly reliable to diagnose deep endometriosis, cystic ovarian endometriosis, and cul-de-sac obliteration. CA-125 concentrations were higher during menstruation and correlated with deep endometriosis and with deep and cystic ovarian endometriosis. Nodularities at clinical examination or follicular phase CA-125 concentrations > 35 U/mL are useful to decide that a bowel preparation should be given, achieving a sensitivity of 87% and a specificity of 83%. In the clinical validation study, deep endometriosis was found in 14 of 16 women.Conclusion Clinical examination during menstruation can diagnose reliably deep endometriosis, cystic ovarian endometriosis, or cul-de-sac adhesions. This test, preferentially combined with a follicular phase CA-125 assay, should be used to decide whether a preparation for bowel surgery should be given.
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Most women with deep endometriosis have severe pain, especially during menstruation, but some large lesions (estimated 5%) are not painful.
“Although most women with deep endometriosis have severe pain, especially during menstruation (65), some large lesions (estimated to be 5%) are not painful.”
From Pathogenesis of endometriosis: The genetic/epigenetic theory (2019) · cites this paper as [65]
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- Authors
- Koninckx, P. R., Meuleman, C., Oosterlynck, D., & Cornillie, F. J.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- ORCID
- Meuleman, Christel
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 1996-02
- Volume
- 65
- Issue
- 2
- Pages
- 280-287
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W4295691139
- Cited by
- 183
- References
- 24
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 4 · 2019: 5 · 2018: 7 · 2017: 7 · 2016: 6 · 2015: 6 · 2014: 4 · 2013: 4 · 2012: 10
- FWCI
- 3.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- PubMed
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- deep infiltrating endometriosis, CA125, bowel preparation, sensitivity and specificity
- MeSH terms
- Endometriosis, Female, Humans, Menstruation, Prospective Studies, Retrospective Studies, Sensitivity and Specificity, CA-125 Antigen
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