Epidemiology of endometriosis among parous women

doi:10.1016/0029-7844(95)00074-2

Obstetrics & Gynecology

Volume 85, Issue 6, June 1995, Pages 983-992

https://doi.org/10.1016/0029-7844(95)00074-2 Get rights and content

Objective

To report the prevalence of endometriosis and its associated risk factors among multiparous women, and to determine the relationship between the location and depth of this disease and certain medical and behavioral characteristics.

Methods

Over a 6-year period, 3384 multiparous women underwent laparoscopy for tubal sterilization. Endometriosis was detected in 126 patients (3.7%), who were consequently evaluated for severity of the disease. To conduct a case-control study, 504 patients with no evidence of endometriosis were randomly selected from a group of women who underwent sterilization. Information obtained through physical examination and a self-administered questionnaire was studied by multivariate logistic regression analysis.

Results

Most endometriosis lesions were minimal. Factors associated with an increased risk for endometriosis included: advanced age (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.1–3.7), Asian race (OR 8.6, 95% CI 1.4–20.1), long cycle length (OR 1.8, 95% CI 1.1–2.7), one live birth (OR 2.2, 95% CI 1.1–4.3), long duration of intrauterine device use (OR 3.0, 95% CI 1.1–8.1), and long duration of uninterrupted menstrual cycles (OR 2.9, 95% CI 1.3–6.4). Present oral contraceptive use was protective for disease (OR 0.5, 95% CI 0.2–0.9). The role of these factors varied among different disease locations (ovary, uterus and tubes, posterior broad ligaments and cul-de-sac), and depth (superficial or deep).

Conclusions

The prevalence of endometriosis is relatively low among multiparous women, and certain menstrual and reproductive characteristics are associated with its development. Furthermore, the relationship between various factors and endometriosis appears to be site and depth specific. Our findings suggest that asymptomatic endometriosis may be clinically important.

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Cited by (248)

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Similar to diabetes and unlike many pathogen-induced diseases, endometriosis is likely a result of maladaptation to the evolutionary heritage of humans. The objective of this article is to review the literature and improve understanding of the evolutionary factors behind endometriosis, leading to more effective prevention and treatment approaches. In primates, spontaneous decidualization of the endometrium evolved to ensure optimal implantation of a limited number of early embryos, unlike many non-primates which depend on early embryos to induce decidualization and subsequent pregnancy. Spontaneous decidualization results in menstrual bleeding when embryo implantation does not occur, and endometriosis is commonly believed to be caused by retrograde menstruation. Although direct evidence is lacking, it is likely that hunter–gatherer women experienced fewer menstrual periods due to pregnancy shortly after menarche, followed by repeated pregnancies and lactation. However, the mismatch between the evolved uterine physiology and rapid societal changes has led to modern women delaying pregnancy and experiencing numerous menstrual periods, potentially increasing the incidence of endometriosis. The symptoms of endometriosis are often managed by suppressing menstruation through systemic hormonal treatments, but these may have side effects. For patients with a family history of endometriosis or in the early stages of the disease, intrauterine devices releasing progesterone locally could prevent uterine bleeding and the development of endometriosis while preserving fertility and minimizing side effects.
B-cell lymphoma 6 expression is not associated with live birth in a normal responder in vitro fertilization population
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Citation Excerpt :
Additionally, individual patient characteristics including age, BMI and markers of ovarian reserve were not associated with BCL6 overexpression. Although some women with endometriosis demonstrate symptoms and findings on imaging, others do not (20, 21). It has been hypothesized that silent endometriosis may be missed in the infertility population, especially now that laparoscopy for diagnosis is used less often (22, 23).
To determine whether increased endometrial B-cell lymphoma 6 (BCL6) expression is associated with live birth in a normal responder in vitro fertilization (IVF) population.
Case-control study.
University-affiliated infertility center.
Two groups of women undergoing IVF with preimplantation genetic testing for aneuploidy followed by warmed, single, euploid embryo transfer. Group 1 consisted of women who failed to achieve live birth, and group 2 consisted of women who achieved live birth.
None.
Endometrial BCL6 expression measured by immunohistochemistry in endometrial tissue samples. Overexpression was defined by mean HSCORE with a cutoff of positivity of >1.4, as previously described in the literature.
Twenty-seven patients who achieved live birth and 23 patients who failed to achieve live birth were included. B-cell lymphoma 6 expression/HSCORE and live birth rate were not associated (Odds ratio [OR], 0.78 [0.24–2.55]). Using a cutoff of >1.4 for positivity, 8 of 23 samples were positive for BCL6 in the no live birth group, whereas 7 of 27 were positive in the live birth group. There was no significant association between BCL6 positivity and live birth (OR, 0.66 [0.19–2.21]).
The proportion of patients with BCL6 positivity did not significantly differ between those who achieved live birth and those who did not. In the population of patients at our center, who compromise of women who respond normally to IVF stimulation, BCL6 overexpression was not associated with IVF success. Physicians implementing BCL6 testing as a diagnostic tool for clinical decision making should counsel patients that results may have limited utility in predicting IVF outcomes in this population.
La expresión de células B de linfoma 6 no se asocia con nacido vivo en una población normo-respondedora en fecundación in vitro.
Determinar si la expresión aumentada de células B de linfoma 6 endometriales (BCL6) está asociada con nacido vivo en una población normo-respondedora en fecundación in vitro (IVF).
Estudio caso-control.
Centro de infertilidad afiliado a universidad.
Dos grupos de mujeres sometidas a IVF con test genético preimplantacional para aneuploidías seguido de transferencia de embrión único euploide. El grupo 1 consistió en mujeres que fallaron en lograr nacido vivo, y el grupo 2 consistió en mujeres que lograron nacido vivo.
Ninguno.
Expresión de BCL6 endometriales medida por inmunohistoquímica en muestras de tejido endometrial. La sobreexpresión fue definida por la media de HSCORE con un punto de corte de positividad > 1.4, como previamente descripto en la literatura.
Veintisiete pacientes que lograron nacido vivo y 23 pacientes que fallaron en lograr nacido vivo fueron incluidas. La expresión de células B de linfoma 6/ HSCORE y la tasa de nacido vivo no se asociaron (Odds ratio [OR] 0.78 [0.24-2.55]). Utilizando un corte > 1.4 para positividad, 8 de 23 muestras fueron positivas para BCL6 en el grupo de no nacidos vivos, mientras que 7 de 27 fueron positivas en el grupo de nacidos vivos. No hubo asociación significativa entre BCL6 positivo y nacido vivo (OR, 0.66 [0.19-2.21].
La proporción de pacientes con BCL6 positivo no difirió significativamente entre aquellas que lograron nacido vivo y aquellas que no. En la población de pacientes de nuestro centro, que se compone de mujeres que respondieron normalmente a la estimulación para IVF, la sobreexpresión de BCL6 no se asoció con el éxito en IVF. Los médicos implementando test de BCL6 como una herramienta diagnóstica para la toma de decisiones clínicas deberían aconsejar a los pacientes que los resultados podrían tener una utilidad limitada en predecir los resultados de IVF en esta población.
Imaging Spectrum of Endometriosis (Endometriomas to Deep Infiltrative Endometriosis)
2020, Radiologic Clinics of North America
Is Endometriosis More Common and More Severe Than It Was 30 Years Ago?
2020, Journal of Minimally Invasive Gynecology
Current estimates of endometriosis prevalence and incidence are highly variable, leading to uncertainty regarding true endometriosis frequency or validity of quantified changes over time. We present a comprehensive review of the prevalence, incidence, and stage of endometriosis worldwide as reported over the past 30 years.
We conducted a systematic search of observational studies using the PubMed, Web of Science, EMBASE, and CINAHL databases to identify research papers published in English between January 1989 and June 2019. Search terminologies were limited to titles containing endometriosis and prevalence or incidence, or epidemiology, or frequency, or occurrence, or statistics.
Two independent reviewers screened abstracts for study eligibility, and data from included studies were abstracted.
Overall, 69 studies describing the prevalence and/or incidence of endometriosis met the inclusion criteria. Among these, 26 studies involved general population samples, 17 of which were from regional/national hospitals or insurance claims systems. The other 43 studies were conducted in single clinic or hospital settings. Prevalence estimates for endometriosis widely varied from 0.2% to 71.4% depending on the population sampled. The prevalence reported in general population studies ranged from 0.7% to 8.6%, whereas that reported in single clinic- or hospital-based studies ranged from 0.2% to 71.4%. When defined by indications for diagnosis, endometriosis prevalence ranged from 15.4% to 71.4% among women with chronic pelvic pain, 9.0% to 68.0% among women presenting with infertility, and 3.7% to 43.3% among women undergoing tubal sterilization. A meta-regression was conducted with year as the predictor of prevalence. No trend across time was observed among “general population in country/region” studies (β = 0.04, p = .12) or among “single hospital or clinic” studies (β = ˗0.02, p = .34); however, a decrease over time was observed among general population studies abstracted from health systems or insurance systems (β = −0.10, p = .005).
As with all human studies, population sampling and study design matter. Heterogeneity of inclusion and diagnostic criteria and selection bias overwhelmingly account for variability in endometriosis prevalence estimated across the literature. Thus, it is difficult to conclude if the lack of observed change in frequency and distribution of endometriosis over the past 30 years is valid.
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Frequency of cul-de-sac obliteration in surgery for pelvic organ prolapse: a retrospective analysis
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View all citing articles on Scopus

View full text

Epidemiology of endometriosis among parous women

Objective

Methods

Results

Conclusions

Fertil Steril

Fertil Steril

Fertil Steril

Am J Obstet Gynecol

Fertil Steril

Fertil Steril

Am J Obstet Gynecol

Am J Obstet Gynecol

Menstrual symptoms in women with pelvic endometriosis

Br J Obstet Gynaecol

Mild endometriosis and infertility: A critical review of epidemiologic data, diagnostic pitfalls and classification limits

Obstet Gynecol Surv

Evidence for the risk of pelvic endometriosis by age race and socioeconomic status

Epidemiol Rev

Endometriosis in multiparous women

J Reprod Med

Endometriosis in adolescents

J Reprod Med

Endometriosis and black woman

J Reprod Med

Laparoscopy in 100 women with chronic pelvic pain

Obstet Gynecol

A. Endometriosis: Its association with retro-grade menstruation, dysmenorrhoea and tubal pathology

Br J Obstet Gynaecol

Endometriosis in women at interval sterilization

Acta Obstet Gynecol Scand