Changing trends in the diagnosis of endometriosis: A comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility

Dmowski, W. Paul; Leśniewicz, R; Rana, Nasir; Pepping, Peg; Noursalehi, Mojtaba

doi:10.1016/s0015-0282(97)81904-8

Cited by 139 publications

(79 citation statements)

References 18 publications

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“…For example, consistent with the current study, some researchers have found no association between disease stage and the presence of dysmenorrhea (2,5,13,19), whereas others have reported such an association (1,4,14,20,21). Whereas most researchers have found that dyspareunia is not related to disease stage (2,5,19,22), in the current study dyspareunia was a more common symptom leading to diagnosis in women with group I disease.…”

Section: Discussionsupporting

confidence: 85%

Differences in characteristics among 1,000 women with endometriosis based on extent of disease

Sinaii

Plumb

Cotton

et al. 2008

Fertility and Sterility

197

127

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Objective-To determine the relationship between disease severity and patient characteristics in endometriosis.Design-Cross-sectional study of self-reported survey data. Setting-Academic research setting. Patient(s)-One thousand women in the Oxford Endometriosis Gene (OXEGENE) study. Intervention(s)-None.Main Outcome Measure(s)-Participants were assigned to one of two groups with predominantly revised AFS stage I-II (group I, n = 423) or III-IV disease (group II, n = 517). Their characteristics were compared by disease extent.Result(s)-Most participants were white (96%) and of reproductive age (81%). Women in group I were significantly younger on entering the study (39.9 ± 0.5 vs. 44.5 ± 0.4 years). Overall time to diagnosis did not differ between groups. The most common symptoms leading to a diagnosis were dysmenorrhea (79%) and pelvic pain (69%). In group II, subfertility (21.5% vs. 30.0%) and an ovarian mass (7.3% vs. 29.4%) more commonly led to a diagnosis, whereas dyspareunia (51.1% vs. 39.5%) was significantly more common in group I. Subfertility (41.5% vs. 53.4%) remained more common in group II throughout reproductive life, although birth and miscarriage rates were similar. Conclusion(s)-Pelvicpain is common to all with endometriosis and those with more extensive disease report higher rates of subfertility. Remarkably, the time to diagnosis was similar among women. KeywordsEndometriosis; patient characteristics; extent of disease; pelvic pain; subfertility Chronic pelvic pain, defined as persistent pain in the pelvis, is the most common symptom associated with endometriosis, yet there is no clear relationship between the severity of the Reprint requests: Ninet Sinaii, Ph.D., 10 Center Drive, Building 10, Room 2N-228, Bethesda, MD 20892-1871 (FAX: 301-496-0457; sinaiin@mail.nih.gov NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript pain experienced and the extent of disease, irrespective of which classification system is used.Researchers have found either no association between pain symptoms and disease stage (1-3) or observed a degree of association between pain and the presence of adnexal adhesions, rectal and vaginal infiltration, ovarian involvement, or endometriomas (2,4,5). The failure of many women with minimal endometriosis to respond to surgical treatment has led some investigators to question whether this is even a cause of pain (6), especially as it may be an incidental finding in asymptomatic women (7,8).The relationship between subfertility and disease stage is similarly uncertain. Some researchers have found no association between stage and subfertility (1), whereas others report that fertility decreases with increasing disease severity (9).Although studies have reported an increased risk of other diseases among women with endometriosis (10-12), evidence is lacking as to how these other conditions are influenced by stage of disease. Women with endometriosis, regardless of stage, appear to have similar ages at menarche and menstrual patterns (13). Health and li...

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Section: Discussionsupporting

confidence: 85%

Differences in characteristics among 1,000 women with endometriosis based on extent of disease

Sinaii

Plumb

Cotton

et al. 2008

Fertility and Sterility

197

127

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“…In addition, women complain that although physicians had several opportunities to reach an early diagnosis, these were often ignored 8 . In general, the delay in diagnosis was greater in young women and those complaining of pelvic pain than in women with infertility 3,9 . Most surveys on endometriosis have been conducted with patients, although the importance of evaluating medical attitudes has been emphasized by endometriosis association groups and the international scientific community.…”

Section: Introductionmentioning

confidence: 93%

Current practice in the management of symptoms of endometriosis: a survey of Brazilian gynecologists

Petta¹,

Matos²,

Bahamondes³

et al. 2007

Rev. Assoc. Med. Bras.

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“…mas mínimas e leves podem se agravar com o passar do tempo 2,3,4 . Além disso, a afecção tem sua gravidade relacionada com a freqüência, quantidade e duração das menstruações.…”

Section: Introductionunclassified

Endometriose vesical: aspectos diagnósticos e terapêuticos

Tobias-Machado¹,

Riezzo²,

Barbosa³

et al. 2001

Rev. Assoc. Med. Bras.

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INTRODUÇÃOEndometriose é a presença de tecido endometrial ectópico e/ou estroma fora da cavidade uterina. Foi observada, pela primeira vez, por Rokitansky (1869) em material de necrópsia. Mais tarde, Sampson (1927) definiu a endometriose como um achado de tecido com aspectos histológicos e funcionais semelhantes ao endométrio tópico, em outros locais.A endometriose é a segunda afecção cirúrgica ginecológica, perdendo apenas para a miomatose uterina. Nos EUA é a terceira causa de internação e a causa mais comum de histerectomia 1 .Nos últimos anos têm-se verificado um aumento da freqüência de endometriose. Esse aumento se deve às mudanças de hábitos femininos; aumento da idade da primeira gestação, maior intervalo entre as gestações, o que promove maior tempo de exposição estrogênica e maior freqüência de menstruações.A endometriose pode causar alteração da fertilidade, dor pélvica ou até ser assintomática. Possui estágios diferentes de evolução, podendo se apresentar de forma mínima, leve, moderada ou grave. As for-UNITERMOS: Endometriose. Cirurgia endoscópica. Doenças do trato urinário.KEY WORDS: Endometriosis. Endoscopic surgery. Urinary tract diseases.mas mínimas e leves podem se agravar com o passar do tempo 2,3,4 . Além disso, a afecção tem sua gravidade relacionada com a freqüência, quantidade e duração das menstruações. ETIOPATOGENIATeoria do implante endometrial explica o aparecimento da endometriose em cicatriz de cesáreas ou após histerectomias.Teoria da metaplasia celômica justifica o desenvolvimento da endometriose em mulheres com agenesia uterina.A disseminacão por via hematogênica justifica as formas extraperitoneais.A teoria do refluxo tubário do fluido menstrual ocorre com maior freqüência nos locais onde o fluido menstrual se deposita 5 .Alguns autores sugerem a participação do sistema autoimune 6,7,8 . Acreditase na diminuição da atividade de linfócitos denominados "natural killers" que agiriam contra antígenos endometriais autó-logos. A diminuição da atividade dessas células estaria relacionada com a gravidade da doença 9 .Recentemente, estudou-se a possibilidade de que a endometriose peritoneal e os nódulos endometrióticos no septo retovaginal fossem duas entidades distintas e foi proposto designá-las de adenomiose retovaginal 10,11 . INCIDÊNCIAA endometriose incide em 10% das mulheres entre 25 a 40 anos de idade. Acomete em até 50% mulheres inférteis 12-16 e possui sua maior freqüência em nulíparas. Em assintomáticas pode incidir de 6% 17 até 43% 18 .Os locais mais acometidos são o fundo de saco de Douglas, ovários, ligamento redondo, tubas uterinas, cérvix, vagina.Apenas 1 a 2% dos casos de endometriose acomete o trato urinário, sendo que a bexiga é acometida em 84% dos casos 19 e, em seguida, o ureter. Na bexiga, as regiões mais freqüentemente acometidas são o trígono e o colo vesical. A tabela 1 mostra a freqüência de endometriose de trato urinário.Como diagnóstico diferencial da endometriose vesical temos: angiomas, papilomas, inflamação ou úlcera vesical localizada e carcinoma infiltra...

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Changing trends in the diagnosis of endometriosis: A comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility

Cited by 139 publications

References 18 publications

Differences in characteristics among 1,000 women with endometriosis based on extent of disease

Differences in characteristics among 1,000 women with endometriosis based on extent of disease

Current practice in the management of symptoms of endometriosis: a survey of Brazilian gynecologists

Endometriose vesical: aspectos diagnósticos e terapêuticos

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