Epidemiology of endometriosis
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- 1.Epidemiology of Endometriosis Presented by: Khaled A.Abdel Aziz El Setohy Lecturer of OB & GYNCairo university
2. Objectives of the talk
- Epidemiological studies
- 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
- Potentially contributing to complications such as:
- chronic pelvic pain
- menstrual irregularities
- (Cramer et al 2002)
- 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)
- 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).
- 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.
- 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.
- 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).
- 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)
- 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)
- 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