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

Abstract

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...

Effect of surgical removal of endometriomas on cyclic and non-cyclic pelvic pain

“…The prevalance of endometriosis in asymptomatic women in general population are not known, but pain is the most common symptom associated with endometriosis, diagnosed by visulization of pelvic organs via laparoscopy. Approximately three quarters of symptomatic patients experience nonmenstrual pelvic pain and/or dysmenorrhea (20). In the present study, all participants had different types of pain as follows: 91% had NCPP, 78% had dysmenorrhea, and 21.7% had dyspareunia.…”

Can symptomatology help in the diagnosis of endometriosis? Findings from a national case–control study—Part 1

“…Moreover, one symptom that rarely appeared in the GP records was dyschezia, with only two cases and three controls being identified as suffering from this symptom. Since studies have shown that 29% of women with endometriosis experience bowel pain, 28 it would seem that dyschezia is either not being reported to GPs or is not being recorded in the GP medical records as dyschezia. This, together with the finding that abdominal pain was recorded frequently in women with endometriosis, may in part explain the reason for an increased diagnosis of IBS among women with endometriosis, with GPs possibly perceiving women's symptoms as bowel related.…”

“…28 These differences in fertility rates may arise from the broader age range in our population (15-55 years), with young women not yet experiencing fertility problems. It is also possible that there is an under-reporting of fertility problems in the GP records, although this is unlikely as GPs are required to record all major medical history and women in the UK generally access fertility services via the GP.…”

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“…Notably, it is also present in 20-40% of women undergoing IVF and is often associated with lower rates of live births, clinical pregnancy and implantation rates [3][4][5]. Women with Stage III and IV endometriosis can develop endometriomas, or cysts arising from ectopic endometrial tissue implanted in the ovary with invagination of the ovarian cortex.…”