Comparison of menstrual blood and endometrial biopsy as specimens in the diagnosis of female genital tuberculosis: a systematic review

TL;DR

This study compares menstrual blood and endometrial biopsy for diagnosing female genital tuberculosis, suggesting menstrual blood could be a less invasive alternative.

Contribution

The study systematically evaluates menstrual blood as a non-invasive diagnostic sample for female genital tuberculosis.

Findings

Menstrual blood tests showed comparable specificity to endometrial biopsy for diagnosing FGTB.

Sensitivity of menstrual blood ranged from 33.3% to 91.7%, while endometrial biopsy ranged from 64.8% to 95.8%.

Abstract

Female genital tuberculosis (FGTB) continues to be a significant problem worldwide. Endometrial biopsy (EB) is the most effective sample for detecting FGTB. However, biopsy is invasive and causes unwarranted suffering. Furthermore, a few studies have investigated non-invasively obtained menstrual blood (MB) as an alternative diagnostic sample for detecting FGTB. Hence, in this study, we are assessing MB as an alternative sample to EB for diagnosing FGTB.

A systematic literature search was conducted using the electronic databases PubMed, Scopus, Web of Science, and Embase until September 2024. All original studies that compared MB with samples of EB for diagnosing FGTB were included.

A total of nine studies were obtained. The sensitivity of tests using MB as a sample ranged from 33.3% to 91.7%, while the specificity ranged from 82.9% to 97.3%. In the EB group, the sensitivity ranged from 64.8% to 95.8%, and the specificity ranged from 84.3% to 97.5%.

The review suggests that MB could be a potential sample for diagnosing FGTB, as the specificity of tests using this sample is comparable to that from the EB group.

The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number CRD42024509199.

The online version contains supplementary material available at 10.1186/s12879-026-12564-8.

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