Epidemiology of Epidemiology of EndometriosisEndometriosis

Presented by:Presented by:

Khaled A.Abdel Aziz El SetohyKhaled A.Abdel Aziz El SetohyLecturer of OB & GYN Lecturer of OB & GYN

Cairo universityCairo university

Objectives of the talkObjectives of the talk

► IntroductionIntroduction► ImpactImpact►PrevalencePrevalence►Epidemiological studiesEpidemiological studies

IntroductionIntroduction► Endometriosis is defined as the presence of Endometriosis is defined as the presence of

endometrial tissue outside the uterine cavity.endometrial tissue outside the uterine cavity.► When this extrauterine endometrial tissue responds When this extrauterine endometrial tissue responds

to hormonal stimulation, the resultant bleeding can to hormonal stimulation, the resultant bleeding can lead to lead to inflammation inflammation scarringscarring

► Potentially contributing to complications such as:Potentially contributing to complications such as: dysmenorrheadysmenorrhea chronic pelvic painchronic pelvic pain dyspareunia dyspareunia menstrual irregularities menstrual irregularities infertilityinfertility(Cramer et al 2002)(Cramer et al 2002)

IntroductionIntroduction

► The public health burden of endometriosis The public health burden of endometriosis remains elusive. remains elusive. (Cramer et al 2002)(Cramer et al 2002)

► Because the symptoms are nonspecific, it is Because the symptoms are nonspecific, it is generally agreed that determination of the generally agreed that determination of the presence or absence of endometriosis presence or absence of endometriosis requires surgical visualization and/or a requires surgical visualization and/or a positive histologic examination positive histologic examination (Hurd et al (Hurd et al 1998).1998).

► Endometriosis affects approximately 10% of Endometriosis affects approximately 10% of the female population in their fertile years the female population in their fertile years (Eskenazi et al 1997)(Eskenazi et al 1997)

IntroductionIntroduction

► In fact, prevalence rates of endometriosis In fact, prevalence rates of endometriosis vary widely from study to study, depending vary widely from study to study, depending on the population surveyed. on the population surveyed.

► Prevalence rates of endometriosis range from Prevalence rates of endometriosis range from 0.7% to 45%0.7% to 45% in surveys of in surveys of asymptomaticasymptomatic women women

(Farquhar et al 2000)(Farquhar et al 2000) 20% to 40%20% to 40% in in infertileinfertile women women (Mahmood et al (Mahmood et al

1991)1991) 6% to 18%6% to 18% in women undergoing in women undergoing sterilizationsterilization

((MatorrasMatorras et al 1995) et al 1995) and and 15% to 70%15% to 70% in patients with in patients with chronic abdominal chronic abdominal

painpain (Stanford et al 2005). (Stanford et al 2005).

IntroductionIntroduction

► Endometriosis in the United States, has a Endometriosis in the United States, has a reported annual incidence of reported annual incidence of 1.9 cases per 10001.9 cases per 1000 women, aged women, aged 15 to 4915 to 49 years years (Leibson et al 2004)(Leibson et al 2004)

► Studies have shown that African-American Studies have shown that African-American women have lower incidence rates than white women have lower incidence rates than white Americans, while Asian Americans seem to have Americans, while Asian Americans seem to have higher rates than white women higher rates than white women (Kyama et al (Kyama et al 2004)2004)

► For Hispanic women however, comparative data For Hispanic women however, comparative data are lacking, although this group now represents are lacking, although this group now represents the fastest growing minority population in the the fastest growing minority population in the United States.United States.

ImpactImpact

►The impact of endometriosis renders The impact of endometriosis renders the life of patients least to say the life of patients least to say problematic. problematic.

►Dilemmas of protocols and exposure Dilemmas of protocols and exposure to lengthy forms of treatment or to lengthy forms of treatment or surgical options is a defined aspect of surgical options is a defined aspect of endometriosis.endometriosis.

ImpactImpact

► Regarding fertility,there is a general consensus Regarding fertility,there is a general consensus that medical treatment is useless in the that medical treatment is useless in the management of endometriosis-associated management of endometriosis-associated infertility whereas conservative surgery and IVF infertility whereas conservative surgery and IVF are valuable options are valuable options (Ozkan et al 2008) (Ozkan et al 2008)

► In particular, despite the scientific evidence not In particular, despite the scientific evidence not being robust, conservative surgery is currently being robust, conservative surgery is currently considered the first-line treatment option for considered the first-line treatment option for endometriosis-associated infertility in women endometriosis-associated infertility in women with all stages of the disease (with all stages of the disease (Vercellini et al Vercellini et al 2009). 2009).

ImpactImpact

►Data from recent large case series Data from recent large case series have documented cumulative rate of have documented cumulative rate of recurrences as high as 30recurrences as high as 30––40% at 2440% at 24––36 months of follow-up 36 months of follow-up (Porpora et al (Porpora et al 2008, Vercellini et al 2008)2008, Vercellini et al 2008)

ImpactImpact

► Although Endometriosis is generally regarded Although Endometriosis is generally regarded as a benign condition, it shows some as a benign condition, it shows some characteristics reminiscent of malignancy, characteristics reminiscent of malignancy, such as such as development of local and distant foci development of local and distant foci and attachment to and invasion of other tissues and attachment to and invasion of other tissues with subsequent damage to the target organs with subsequent damage to the target organs

(Garry et al 2001)(Garry et al 2001)► In the last decade, based on epidemiological In the last decade, based on epidemiological

and biological studies, endometriosis has and biological studies, endometriosis has been associated with a definite increase in been associated with a definite increase in risk of various malignancies risk of various malignancies (Olson 2002)(Olson 2002)

EpidemiologyEpidemiology► Previous studies have reported an association between Previous studies have reported an association between

endometriosis and the following risk factors: endometriosis and the following risk factors: higher socioeconomic status higher socioeconomic status (Bennet et al 1953),(Bennet et al 1953), single marital status single marital status (Cramer et al 1986),(Cramer et al 1986), early menarche early menarche (Moen et al 1997(Moen et al 1997),), shorter menstrual cycles with longer duration of flow shorter menstrual cycles with longer duration of flow (Mahmood et al (Mahmood et al

1991)1991) dysmenorrhea dysmenorrhea (Kirshon 1988)(Kirshon 1988) nulliparity nulliparity (Buttram 1979)(Buttram 1979) type of contraception type of contraception nonsmoking status ,nonsmoking status , lack of exercise , lack of exercise , cervical conization , cervical conization , scoliosis , scoliosis , dysplastic nevi , dysplastic nevi , and family history of endometriosis and family history of endometriosis and melanoma .and melanoma .

► Few studies on endometriosis have compared patients from different Few studies on endometriosis have compared patients from different geographic locations geographic locations (Cramer et al 1996).(Cramer et al 1996).

►We believe cross-cultural studies are We believe cross-cultural studies are valuable because they expose cultural valuable because they expose cultural and regional differences in symptoms and regional differences in symptoms and establish universal disease and establish universal disease constants. constants.

►To the best of our knowledge this is To the best of our knowledge this is the first study handling epidemiology the first study handling epidemiology of endometriosis in Egyptian females.of endometriosis in Egyptian females.

Thank youThank you