Title: Quality of life and symptoms of pain in patients with endometriomas compared to those
with other endometriosis lesions: a cross-sectional study
Version: 0 Date: 18 Dec 2023
Reviewer's report:
The researchers conducted a study examining the quality of life and pain scores in patients with
endometrioma versus other types of endometriosis lesions. While the findings are intriguing, I
have identified major concerns, including potential selection bias and a cross-sectional design,
and minor concerns such as incomplete reporting of participant characteristics and limited
discussion on limitations:
Selection Bias: The paper lacks information on the representativeness of the study population.
The participants were recruited from a specific clinical setting, raising concerns about
generalizability to the broader population of women with endometriosis.
Cross-Sectional Design: The cross-sectional design limits the ability to establish causation
between different types of endometriosis and quality of life or pain experiences. A longitudinal
design would be more appropriate for exploring changes over time.
Incomplete Description of Methods: The paper lacks details on how participants were initially
screened, potentially leading to concerns about the consistency of inclusion criteria application
and the possibility of selection bias.
Incomplete Reporting of Ethical Approval: While ethical approval was mentioned, essential
details such as the name of the ethics committee and the specific approval reference number are
missing, which hinders transparency and thorough evaluation.
Limited Diagnostic Criteria Information: The inclusion criteria allow various methods for
diagnosing endometriosis, including ultrasound, MRI, surgery, or histology. This variability
may introduce heterogeneity, affecting the validity of the study's findings.
Confounding Variables: Although the paper mentions adjustment for various demographic and
clinical factors in the statistical analysis, there might still be unaccounted confounding variables
influencing the outcomes.
Post Hoc Power Calculation: While a post hoc power calculation was performed, the absence of
a predetermined sample size calculation raises concerns about the adequacy of the sample size
for the study objectives and the potential for Type II errors.
Limited External Validity: The study's focus on a specific geographical region (Canadian or
North American participants) raises concerns about the external validity of the findings for a
more diverse global population of women with endometriosis.
Minor Concerns:
Incomplete Participant Characteristics: The paper lacks a detailed description of certain
participant characteristics, such as the distribution of participants across different age groups,
which may be relevant for understanding the study population.
Insufficient Context on Prior Research: The paper briefly mentions earlier research on
endometriosis-associated pain but lacks a comprehensive review of relevant literature, making
it challenging to place the current study in a broader context.
Insufficient Explanation of Findings: The paper does not provide sufficient interpretation or
discussion of why specific symptoms (e.g., deep dyspareunia) showed differences between
endometrioma and non-endometrioma groups.
Limited Discussion on Limitations: The discussion section could benefit from a more extensive
exploration of the study's limitations, including potential biases and sources of error, to enhance
the paper's transparency.
Inconsistency in Terminology: The paper uses different terms to describe the same outcome
measure, such as "quality of life" and "QoL," which may cause confusion and inconsistency in
the paper.