Epidemiology of endometriosis

download Epidemiology of endometriosis

of 21

Embed Size (px)

Transcript of Epidemiology of endometriosis

  • 1.Epidemiology of Endometriosis Presented by: Khaled A.Abdel Aziz El Setohy Lecturer of OB & GYNCairo university

2. Objectives of the talk

  • Introduction
  • Impact
  • Prevalence
  • Epidemiological studies

3. Introduction

  • Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity.
  • When this extrauterine endometrial tissue responds to hormonal stimulation, the resultant bleeding can lead to
    • inflammation
    • scarring
  • Potentially contributing to complications such as:
    • dysmenorrhea
    • chronic pelvic pain
    • dyspareunia
    • menstrual irregularities
    • infertility
    • (Cramer et al 2002)

4. Introduction

  • The public health burden of endometriosis remains elusive.(Cramer et al 2002)
  • Because the symptoms are nonspecific, it is generally agreed that determination of the presence or absence of endometriosis requires surgical visualization and/or apositive histologic examination(Hurd et al 1998).
  • Endometriosis affects approximately 10% of the female population in their fertile years(Eskenazi et al 1997)

5. Introduction

  • In fact, prevalence rates of endometriosis vary widely from study to study, depending on the population surveyed.
  • Prevalence rates of endometriosis range from
    • 0.7% to 45%in surveys ofasymptomaticwomen(Farquhar et al 2000)
    • 20% to 40%ininfertilewomen(Mahmood et al 1991)
    • 6% to 18%in women undergoingsterilization ( Matorraset al 1995)
    • and15% to 70%in patients withchronic abdominal pain (Stanford et al 2005).

6. Introduction

  • Endometriosis in the United States, has a reported annual incidence of1.9 cases per 1000women, aged15 to 49years(Leibson et al 2004)
  • Studies have shown that African-American women have lower incidence rates than white Americans, while Asian Americans seem to have higher rates than white women(Kyama et al 2004)
  • For Hispanic women however, comparative data are lacking, although this group now represents the fastest growing minority population in the United States.

7. Impact

  • The impact of endometriosis renders the life of patients least to say problematic.
  • Dilemmas of protocols and exposure to lengthy forms of treatment or surgical options is a defined aspect of endometriosis.

8. Impact

  • Regarding fertility,there is a general consensus that medical treatment is useless in the management of endometriosis-associated infertility whereas conservative surgery and IVF are valuable options(Ozkan et al 2008)
  • In particular, despite the scientific evidence not being robust, conservative surgery is currently considered the first-line treatment option for endometriosis-associated infertility in women with all stages of the disease ( Vercellini et al 2009).

9. Impact

  • Data from recent large case series have documented cumulative rate of recurrences as high as 30 40% at 24 36 months of follow-up(Porpora et al 2008, Vercellini et al 2008)

10. Impact

  • Although Endometriosis is generally regarded as a benign condition, it shows some characteristics reminiscent of malignancy, such as
    • development of local and distant foci
    • and attachment to and invasion of other tissues
    • with subsequent damage to the target organs(Garry et al 2001)
  • In the last decade, based on epidemiological and biological studies, endometriosis has been associated with a definite increase in risk of various malignancies(Olson 2002)

11. Epidemiology

  • Previous studies have reported an association between endometriosis and the following risk factors:
    • higher socioeconomic status(Bennet et al 1953),
    • single marital status(Cramer et al 1986),
    • early menarche(Moen et al 1997 ),
    • shorter menstrual cycles with longer duration of flow(Mahmood et al 1991)
    • dysmenorrhea(Kirshon 1988)
    • nulliparity(Buttram 1979)
    • type ofcontraception
    • nonsmoking status ,
    • lack of exercise ,
    • cervical conization ,
    • scoliosis ,
    • dysplastic nevi ,
    • and family history of endometriosis
    • and melanoma .
  • Few studies on endometriosis have compared patients from different geographic locations(Cramer et al 1996).

12. 13. 14. 15. 16. 17. 18. 19. 20.

  • We believe cross-cultural studies are valuable because they expose cultural and regional differences in symptoms and establish universal disease constants.
  • To the best of our knowledge this is the first study handling epidemiology of endometriosis in Egyptian females.

21. Thank you