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Naoko Sasamoto, MD, PhD



Assistant Professor


Brigham and Women's Hospital


Obstetrics and Gynecology


Naoko Sasamoto*, Mary DePari, Allison F. Vitonis, Kurtis Garbutt, Amy L. Shafrir, Amy D. DiVasta, Katy Vincent, Christine B. Sieberg, Krina T. Zondervan, Kathryn L. Terry, Stacey A. Missmer

Principal Investigator

Naoko Sasamoto


Age at pain onset and duration of diagnostic delay in relation to endometriosis-associated pain and comorbidities


Introduction: Impact of pain onset and duration of diagnostic delay on subsequent pain characteristics and comorbidities in endometriosis is unclear.

Aim: Investigate age at pain onset and time to diagnosis associations with current symptoms and comorbidities.

Material/Methods: Among 764 surgically-confirmed endometriosis cases diagnosed due to pain, we quantified current pain-related characteristics and comorbid pain conditions by age at pain onset and duration of diagnostic delay using Fisher’s exact tests and logistic regression.

Results: Median current age was 23y[interquartile range(IQR)=17-31y], age at pain onset was 14y(IQR=13-19y), and time to diagnosis was 3y(IQR=1-6y), with low correlation(rho=-0.16,p<0.001) between onset age and time to diagnosis. Those with age at onset ≤12y vs. ≥25y reported a higher current prevalence of severe dysmenorrhea(86% vs. 74%,p=0.06) and dyspareunia interfering with intercourse/penetration(83% vs. 67%,p=0.06). Those with age at onset ≤12y currently had clinically relevant, higher pain catastrophizing compared to ≥25y (score ≥30=42% vs. 18%,p=0.03), with greater rumination [median=10(IQR=5-13) vs. 6(IQR=3-10)] and helplessness subscale scores [median=12(IQR=7-17) vs. 7(IQR=4-12)]. Those with age at onset ≤12y also reported lower mental component scale and greater fatigue. Adjusting for age at diagnosis, those with diagnostic delay >7y had significantly higher odds of current severe dysmenorrhea [odds ratio(OR)=2.02, 95% confidence interval(CI)=1.13-3.59,p-trend=0.048] and multiple chronic pain conditions (OR=1.63,CI=1.00-2.66,p-trend=0.02) compared to those diagnosed ≤1y.

Conclusion/Impact: Younger endometriosis-associated pain onset was associated with increased pain intensity and exacerbation of pain-related rumination and helplessness, impacting quality-of-life and possibly treatment response. Longer diagnostic delay was associated with severe dysmenorrhea and comorbid pain, suggesting earlier diagnosis may help prevent development of comorbid pain conditions in these vulnerable patient population.”

Research Context