Dysmenorrhea: risk factors in women with endometriosis.

Although it is generally accepted that endometriosis is responsible for dysmenorrhea, as well as other symptoms such as infertility, the precise relationship between the severity of dysmenorrhea and various characteristics of disease, such as stage and the type or site of endometriotic lesions, has been elusive and often a matter of heated debate, owing largely to conflicting reports. Here we review factors that are reported to be associated with dysmenorrhea in endometriosis. We also demonstrate, through a real example, that different statistical models employed in data analyses may yield somewhat different sets of risk factors, and the difference may not be always resolved within the same data set. In addition, we make the point that despite the best-fitting models, there may still be a sizable portion of variation in the severity of dysmenorrhea that can not be explained completely by the identified risk factors, suggesting that factors other than those of surgical findings or patient characteristics may also be responsible for dysmenorrhea severity. We review some possible factors that may also be responsible for the risk and severity of dysmenorrhea. Finally, we expose areas in need of further research.