Determinants of short term recurrence rate of endometriosis

Objective: To analyse the frequency and the determinants of recurrence rate of clinically detectable endometriosis. Study design: Prospective cohort multicenter study. Eligible for the study were all women observed for the first time during the period January–June 1998 at the participating centres with a laparoscopically confirmed first diagnosis of endometriosis. After diagnosis, patients were treated according to standard care of each centre and desire for pregnancy. The protocol required all women to be followed up at the centre each year for 2 years with a clinical examination, an ultrasound pelvic examination and a CA125 assay, unless pregnancy occurred. Second look laparoscopy was performed on a clinical basis. Results: A total of 311 women (median age 36 years) entered the study. The two-year recurrence rate was 5.7% among cases stage I-II and 14.4% among stage III–IV (x2 1 adjusted for indication for surgery, p < 0.05). The recurrence rates tended to increase with age, being 4.6% among women aged 20–30 and 13.1% among women aged >30, but this finding was not statistically significant. Conclusion: The recurrence rate of clinically detectable endometriosis tends to be higher in older women with advanced stages of the disease and lower in women with infertilit

Risk factors for pelvic endometriosis in women with pelvic pain or infertility

Objective: The objective of the study was to analyse the relationship between selected characteristics and risk of pelvic endometriosis. Study design: Eligible for the study were 817 women with primary or secondary infertility or pelvic pain requiring laparoscopy. Of these, 393 were included for infertility and 424 for pelvic pain. Results: A total of 345 (42.2%) had a diagnosis of endometriosis and 472 did not have the disease. Multiparous women had endomertriosos less frequently than nulliparous, the estimated odds ratios (OR) were respectively 0.9 (95% confidence interval, CI, 0.5-1.6) and 0.4 (95% CI 0.2-0.7) in women reporting one and two or more births. In comparison with women reporting no spontaneous abortion, the estimated OR was 0.3 (95% CI 0.2-0.5) in those who reported greater than or equal to 1 miscarriage. In comparison with women reporting menstrual cycles lasting greater than or equal to 25 days subjects with totally irregular menstrual cycles had a reduced risk of endometriosis (OR 0.6, 95% CI 0.3-0.9). No significant association emerged between smoking, age at menarche and risk of endometriosis. Conclusions: this study confirms, with a different methodological approach to previously published studies, that multiparity, a history of abortion and lifelong irregular menstrual pattern decrease the risk of endometriosis in women with pelvic pain and infertility. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved

Determinants of adenomyosis in women who underwent hysterectomy for benign gynecological conditions: results from a prospective multicentric study in Italy

We conducted a cross-sectional study on the frequency and risk factors for adenomyosis in women who underwent hysterectomy for benign gynecological conditions

Left:right side ratio of endometriotic implants in the pelvis

Objective: The frequency of endometriotic lesions in the right and left hemipelvis was analysed in 856 women with endometriosis. Eligible for the study were women with primary or secondary sterility, chronic pelvic pain, fibroids or benign ovarian cysts requiring laparoscopy or laparotomy consecutively observed between May 1991 and July 1992 in 23 obstetric and gynecology departments in Italy. Women with a previous diagnosis of endometriosis were excluded. A total of 3684 women entered the study. Of those, 856 had endometriosis and are considered in the present analysis. Results: Five hundred and ninety four had bilateral lesions (including both ovarian and peritoneal lesions). Of the 262 women with unilateral lesions, 118 (45%, 95% confidence intervals (CI) 38-54) had the lesions in the right side of the pelvis and 144 (55%) in the left one. Conclusions: From an anatomical point of view, these findings support the transplantation therapy in the pathogenesis of endometriosis. \ua9 2003 Published by Elsevier Ireland Ltd

Prevalence and anatomical distribution of endometriosis in women with selected gynecological conditions - results from a multicentric Italian study

We have evaluated the prevalence of endometriosis in selected gynaecological conditions requiring surgery. Eligible for the study were women with primary or secondary sterility, chronic pelvic pain, fibroids or benign ovarian cysts requiring laparoscopy or laparotomy consecutively observed during the study period in 23 obstetrics and gynaecology departments in Italy between May 1991 and July 1992. Women with a previous diagnosis of endometriosis were specifically excluded. A total of 3684 subjects entered the study. Of these, 660 (mean age 31 years) were included for sterility, 409 (mean age 32) for chronic pelvic pain, 1880 (mean age 42) for fibroids and 735 (mean age 33) for benign ovarian cysts. During the surgical procedure surgeons were asked to examine the pelvis carefully to identify endometriosis. Out of the 660 women included for sterility, 195 [30%, 95% confidence interval (CI) 26-35] had endometriosis; the corresponding figures were 185 out of 409 (45%, 95% CI 39-52) for pelvic pain, 219 out of 1880 (12%, 95% CI 10-14) for fibroids and 257 out of 735 (35%, 95% CI 31-40) for ovarian cysts; these differences were significant (x(3)(2) heterogeneity, absence versus presence = 323.9, P < 0.001). Among women with endometriosis who entered the study for sterility, 51% were at stage 1, 22% at stage 2, 20% at stage 3 and 7% at stage 4. The corresponding figures for pelvic pain and fibroids were largely similar: 37%, 24%, 30%, 10% for women with pelvic pain, 36%, 11%, 45% and 8% for those with fibroids, but among cases with ovarian cysts stage 3 was over-represented (62% of cases). The most common sites of endometriosis were, in order of frequency, the ovaries considered together, the posterior cul de sac and uterosacral ligaments. Endometriotic implants were more common on the uterosacral ligaments and the posterior cul de sac among women with sterility and pelvic pain than in those with fibroids and ovarian cysts. The frequency of endometriosis was not directly related to age at surgery, but decreased with increasing parity in all the four criteria for entry groups