☆ 4.6 Article

Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY (2013)

Journal

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY

Volume 208, Issue 6, Pages -

Publisher

MOSBY-ELSEVIER

DOI: 10.1016/j.ajog.2013.02.040

Keywords

Body mass index; dysmenorrhea; endometriosis; epidemiology; infertility; laparoscopy; magnetic resonance imaging; risk factors

Funding

Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health [N01-DK-6-3428, N01-DK-6-3427, 10001406-02]

Ask authors/readers for more resources

Protocol

Community support

Reagent

Community support

Abstract

OBJECTIVE: We sought to identify risk factors for endometriosis and their consistency across study populations in the Endometriosis: Natural History, Diagnosis, and Outcomes (ENDO) Study. STUDY DESIGN: In this prospective matched, exposure cohort design, 495 women aged 18-44 years undergoing pelvic surgery (exposed to surgery, operative cohort) were compared to an age-and residence-matched population cohort of 131 women (unexposed to surgery, population cohort). Endometriosis was diagnosed visually at laparoscopy/laparotomy or by pelvic magnetic resonance imaging in the operative and population cohorts, respectively. Logistic regression estimated the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for each cohort. RESULTS: The incidence of visualized endometriosis was 40% in the operative cohort (11.8% stage 3-4 by revised criteria from the American Society for Reproductive Medicine), and 11% stage 3-4 in the population cohort by magnetic resonance imaging. An infertility history increased the odds of an endometriosis diagnosis in both the operative (AOR, 2.43; 95% CI, 1.57-3.76) and population (AOR, 7.91; 95% CI, 1.69-37.2) cohorts. In the operative cohort only, dysmenorrhea (AOR, 2.46; 95% CI, 1.28-4.72) and pelvic pain (AOR, 3.67; 95% CI, 2.44-5.50) increased the odds of diagnosis, while gravidity (AOR, 0.49; 95% CI, 0.32-0.75), parity (AOR, 0.42; 95% CI, 0.28-0.64), and body mass index (AOR, 0.95; 95% CI, 0.93-0.98) decreased the odds of diagnosis. In all sensitivity analyses for different diagnostic subgroups, infertility history remained a strong risk factor. CONCLUSION: An infertility history was a consistent risk factor for endometriosis in both the operative and population cohorts of the ENDO Study. Additionally, identified risk factors for endometriosis vary based upon cohort selection and diagnostic accuracy. Finally, endometriosis in the population may be more common than recognized.

Authors

I am an author on this paper

Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.6

Not enough ratings

Secondary Ratings

Novelty

Significance

Scientific rigor

Rate this paper

Endometriosis: Classification, pathophysiology, and treatment options

Elma Pasalic, Murtaza M. Tambuwala, Altijana Hromic-Jahjefendic

Summary: The human endometrium is a complex tissue that undergoes a monthly cycle of thickening and shedding without scarring or loss of function. Endometriosis is a reproductive disease where endometrium is found outside the uterus, affecting 6-10% of reproductive-age women worldwide. It causes pain, heavy bleeding, and infertility. The disease is believed to originate from viable endometrial cells that flow back into the peritoneum during retrograde menstruation. Treatment options include surgery, hormonal therapy, medication, diet and exercise, and in severe cases, hysterectomy.

PATHOLOGY RESEARCH AND PRACTICE (2023)