Reviewer’s report
Title: 
Can TSH level and premenstrual spotting constitute a non-invasivemarker
for the diagnosis of endometriosis?
Version: 
0 
Date: 
22 Jun 2021
Reviewer's report:
I think it's okay that TSH and premenstrual spotting are considered non-invasive
markers of endometriosis. But the authors do not mention among the non-
invasive markers for the diagnosis of endometriosis, the clinical examination
(vaginal or rectal examination), nor the transvaginal (or transrectal) ultrasound.
In addition, the medical history does not discriminate between primary or
secondary dysmenorrhea, or between entry or deep dyspareunia. And it seems
that not all women have been asked about these symptoms, since profound
dyspareunia and retrocervical touch findings (Douglas) have a better diagnostic
correlation. I would recommend that they have a visual-analog scale for
endometriosis and that the patient herself fill in; premenstrual spotting should
also be included.
Among the blood test data, the authors also do not mention CA-125; so it is okay
to request TSH, but is this study included all cases with endometriosis or only
those with a determined TSH? Have they not included the tumor marker CA-
125?.
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