Dyspareunia and heavy menstrual bleeding as clinical predictors of concomitant endometriosis in Inflammatory Bowel Disease: A multidisciplinary prospective study

Background: The association between Inflammatory Bowel Disease (IBD) and endometriosis is undefined. Aims: The primary aim was to identify clinical predictors of endometriosis in IBD. Secondary aim was to compare symptoms and IBD characteristics in patients with versus without endometriosis. Methods: Consecutive fertile IBD patients with ≥1 symptom compatible with endometriosis were prospectively enrolled. Pelvic endometriosis was searched by transvaginal ultrasonography (TVUS). Results: The study population included 82 IBD patients (age: 38 [18-53] years): 41 (50%) Crohn’s Disease (CD), 41 (50%) Ulcerative Colitis (UC). Symptoms included: dysmenorrhea (n=72 [87.8%]), dyschezia (n=29 [35.4%]), dyspareunia (n=46 [56.1%]), heavy menstrual bleeding (HMB) (n=50 [60.9%]), chronic abdominal pain (n=22 [26.8%]). TVUS detected endometriosis in 51 (62.2%) patients (CD: 23 [45.1%], UC: 28 [54.9%]), including deep infiltrating endometriosis (DIE) in 44 (86.3%). Dyspareunia, HBM and chronic abdominal pain were more frequent in patients with endometriosis (35 [68.6%] vs 11 [35.5%], p=0.007; 36 [70.6%] vs 14 [45.2], p=0.03; 18 [35.3%] vs 4 [12.9%], p=0.04). Multivariate analysis identifyied dyspareunia and HMB as risk factors for endometriosis (4.7 [1.6-13.9]; p=0.005; 4.3 [1.4-12.9]; p=0.008). Conclusions: Endometriosis may be highly underestimated in IBD, being mostly represented by DIE. Dyspareunia and HMB should be carefully searched in fertile young IBD patients to roule out an undiagnosed endometriosis.