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. 2025 Oct 17.
doi: 10.1007/s00404-025-08191-4. Online ahead of print.

Clinical characterization of endometriosis phenotypes

Louisa Hofbeck  1 , Katharina Au  2 , Simon Blum  2 , Nadezda Sipulina  2 , Laura Lotz  2 , Johannes H Lermann  3 , Stefan P Renner  4 , Peter A Fasching  2 , Matthias W Beckmann  2 , Stefanie Burghaus  2
Affiliations

Clinical characterization of endometriosis phenotypes

Louisa Hofbeck et al. Arch Gynecol Obstet. .

Abstract

Purpose: Endometriosis appears in various forms and symptoms. With regard to the established endometriosis classifications, it is hardly possible to draw conclusions from the endometriosis to the symptoms caused by it. The objective of this study was to evaluate whether different endometriosis phenotypes are associated with distinct pain profiles.

Materials and methods: 3329 patients underwent surgical treatment for endometriosis at the University Endometriosis Center Franconia of the Erlangen University between September 2011 and January 2024. They were grouped by phenotype [superficial (SE), deep (DIE) and adenomyosis (AM)] and assessed for pelvic pain, dyspareunia, dysuria and dyschezia. The study examined pain distribution across phenotypes and pain intensity among symptomatic patients (NRS > 0).

Results: Patients with SE only reported pelvic pain less frequently and with lower intensity than those with additional AM Groups SE/AM and SE/DIE/AM. Dyspareunia was less common in Group SE only vs. Group SE/AM; pain intensity was highest in AM only and lowest in Group SE/DIE. Dysuria was most frequent in Group SE/DIE/AM, with no significant intensity differences. Dyschezia was more frequent in Group SE/DIE/AM and less in Group SE only, again without significant intensity differences.

Conclusion: Pain frequency and intensity differed by endometriosis phenotype. SE showed the lowest pain frequency and pelvic pain intensity. AM, especially with other subtypes, was linked to higher frequency and intensity of pelvic pain, as well as more dyspareunia and dysuria. DIE was mainly associated with more frequent dyschezia, but not with increased pelvic pain intensity.

Keywords: Adenomyosis; Classification; Dyschezia; Endometriosis; Pelvic pain; Symptoms.

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Conflict of interest statement

Declarations. Conflicts of interest: PD Dr. Burghaus has received honoraria for lectures, presentations, and educational events from the Forum für medizinische Fortbildung (FomF GmbH) and the Arbeitsgemeinschaft Endometriose. She has received payment for expert testimony related to the certification of endometriosis centers by EuroEndoCert. She serves as Treasurer of both the Working Group Endometriosis and the Endometriosis Research Foundation. She is also a member of several professional societies, including the DGGG, AGO, AGUB, DKG, and EEL. In addition, she is the coordinator of the Clinical and Scientific Endometriosis Center. Prof. Fasching has received research grants or contracts from Biontech, Cepheid, and Pfizer, with payments made to his institution. He has received personal consulting fees and honoraria for lectures, presentations, and educational events from Novartis, Pfizer, Roche, Daiichi-Sankyo, AstraZeneca, Lilly, Eisai, Merck Sharp & Dohme, Pierre Fabre, SeaGen, Agendia, Sanofi Aventis, Gilead, and Mylan. He has also participated in advisory boards or data safety monitoring boards for the same companies. Dr. Lotz has received personal honoraria for manuscript writing for the journal Hebamme (Thieme Verlag) on the topic of “polycystic ovary syndrome”. All other authors report no conflicts of interest. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Ethical approval was granted by the medical faculty’s ethics committee. Informed consent: Informed consent was obtained from all individual participants included in the study.

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