Epidemiology and risk factors associated with laparoscopically diagnosed typical and atypical endometriosis among Egyptian women

Objectives: To estimate the prevalence of typical and atypical (subtle) pelvic endometriosis as diagnosed by laparoscopy, and to define risk factors for this disease among Egyptian women.
Design: A prospective cross-sectional observational study.
Setting: Gynecologic Endoscopy Units, Assiut and Al-Azhar University Hospitals, Egypt.
Materials and methods: A total of 2493 patients submitted to video-assisted laparoscopy due to any indication. Diagnostic laparoscopy for evidence of typical or subtle endometriotic ovarian, tubal or peritoneal lesions. Biopsy from the lesion was frequently taken for histopathological evaluation.
Main outcome measures: Laparoscopic and histopathologic diagnosis of pelvic endometriosis. Correlating the different patient characteristics and the risk of endometriosis.
Results: Laparoscopically, 469 patients (18.8%) were diagnosed to be endometriosis. Of those, typical and atypical endometriosis were diagnosed in 220 patients (8.8%) and 249 patients (9.98%) respectively. Laparoscopy was indicated as a part of infertility work-up in 2017 patients (80.9%), for chronic pelvic pain in 304 patients (12.2%), and other indications in 172 patients (6.9%). Endometriosis was diagnosed in 182 (38.8%), 219 (46.6%), and 68(14.5%) patients in the 3 groups respectively. Biopsy was taken from 367 cases (78.2%) and significantly correlated with laparoscopy (P=0.001, OR=0.8, 95% CI (0.4 -1.5). Concerning risk factors, only decreased patient’s age (less than 30 years), low parity, and urban residence were significantly correlated with endometriosis. ORs were 0.8, 0.8, and 0.9 with 95% CI of 0.7-3.4, 0.4 -1.6, and 0.4 -1.2 for the 3 risk factors respectively.
Conclusions: Pelvic endometriosis is a common frequently underestimated health problem in Egypt. It is correlated with patient’s age less than 30 years, low parity and urban residence. It should be considered in infertile women and patients with pelvic pain specially those with prior pelvic surgery. Being more commonly diagnosed, subtle endometriosis deserves large sample-sized studies of its impact on women’s health and fertility.