Epidemiology of Endometriosis in Tamil Nadu, India

Abstract

Endometriosis is an enigmatic disease of women of the reproductive age group. Pain and infertility are the main symptoms. This paper attempts to study the incidence of endometriosis among infertility patients undergoing laparoscopy. Following parameters such as age, SE status, body mass index (BMI), type of infertility, parity, symptoms, family history, menstrual history, medical history, ultrasound (USG) findings, stages of endometriosis, associated findings, and laparoscopy findings were analyzed. Incidence of endometriosis was higher between 26 and 35 years and at all ages stage 3 and stage 4 endometriosis were higher than stage 1 and stage 2. Endometriosis is more common in higher socio-economic class and in women with lower BMI and primary infertility. Among all the symptoms of endometriosis, dysmenorrhea is the most common and most important pointer towards the diagnosis of endometriosis. There is also higher incidence of family history among endometriosis patients. Menstrual cycles are invariably regular. Diagnosis of endometriosis is mainly through USG and rarely magnetic resonance imaging is performed to confirm the presence of endometriosis. In early stages of endometriosis, USG may not show any positive findings. USG can pick up endometriomas, deep infiltrative endometriosis, adenomyosis, and associated findings such as polycystic ovary syndrome, fibroids, and Mullerian anomalies. Laparoscopy is the gold standard in the diagnosis and treatment of endometriosis. Staging is done based on laparoscopy and simultaneously treatment is also carried out. Stage 1 and 2 patients underwent cauterization of the lesions. Advanced stages of endometriosis underwent cystectomy, adhesiolysis, and excision of the deep lesions and ultimately the pelvic anatomy is regained. Women were planned for further fertility treatment based on the staging of the disease.

Effects of pentoxifylline and metformin combination therapy compared to metformin alone in infertile women with symptomatic endometrioma

“…The similarity in age and socioeconomic status between the two treatment groups in our study aligns with the findings of Devi et al and Ajayi et al emphasizing that these demographic factors hold constant across different treatment modalities for endometriosis. 20,21 Furthermore, the lack of significant differences in BMI categories (80% in pentoxifylline plus metformin and 69.23% in metformin alone being within the 18.5-24.9 kg/m 2 range) resonates with observations made by Legro et al suggesting that BMI is not a differentiating factor in the treatment response of endometriosis. 22 The substantial reduction in the size of endometrioma, VAS score, and IL-6 levels (all p<0.001s) post-treatment in the pentoxifylline plus metformin group is a remarkable outcome of our study, indicating the potency of this combination therapy.…”