Changing trends in the diagnosis of endometriosis: a comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility

W. Paul Dmowski; Ryszard Lesniewicz; Nasiruddin Rana; Peg Pepping; Mojtaba Noursalehi

doi:10.1016/S0015-0282(97)81904-8

Endometriosis Diagnosis

Changing trends in the diagnosis of endometriosis: a comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility

Dmowski WP, Lesniewicz R, Rana N, Pepping P, Noursalehi M

Published February 1997 Fertility and Sterility, 67(2), 238-243

DOI 10.1016/S0015-0282(97)81904-8 PMID 9022596

RRM Academy Synopsis

At one clinic, endometriosis pain was diagnosed later than infertility

Endometriosis pain took 6.35 years on average to diagnose, infertility 3.13 years. A Chicago clinic reviewed the records of 693 women. The pain wait shrank over three 5-year periods, from 9.21 to 4.63 years. Women who presented with pain also had more advanced disease at diagnosis.

Key Findings

The review covered 693 consecutive new patients seen from 1987 to 1995: 357 with endometriosis and chronic pelvic pain, 336 with endometriosis and infertility.
Mean diagnostic delay, the time from first symptom to first diagnosis, was 6.35 years in the pain group and 3.13 years in the infertility group (P < 0.0001).
In the pain group, diagnostic delay fell from 9.21 years in 1979 to 1984 to 7.17 years in 1985 to 1989 and 4.63 years in 1990 to 1995 (P = 0.0001).
Stage IV disease made up 53.6% of first diagnoses in the pain group in 1979 to 1984 and 21.9% in 1990 to 1995.
At first laparoscopy, 31% of the pain group and 12% of the infertility group had stage IV disease. Longer delay tracked with higher stage only in the pain group (r = 0.24).

Interpretation

This cohort study followed patients at one Chicago clinic. The pain group and the infertility group differed in age, education, and family history. The authors read that as a sign the two forms of the disease differ in some way. Longer delay matched higher stage only in the pain group. The authors call that pattern a sign of disease growth over time. They link the overall drop in delay to wider access to laparoscopy and greater physician awareness. The findings support larger studies of these diagnostic paths.

RRM Context

Restorative reproductive medicine treats pain and infertility as signals that call for a diagnosis of the cause. Both deserve equal urgency. In this cohort, pain waited longest for that diagnosis. The same group had more advanced disease at first laparoscopy.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To compare demographic, epidemiologic, and medical data and to evaluate diagnostic trends in women with endometriosis and chronic pelvic pain symptoms or endometriosis and infertility.

Design

Retrospective analysis.

Setting

Institute for the Study and Treatment of Endometriosis.

Patients

Six hundred ninety-three consecutive patients with endometriosis and chronic pelvic pain (n = 357) or endometriosis and infertility (n = 336).

Interventions

None.

Main Outcome Measures

Demographic and epidemiologic parameters, diagnostic trends.

Results

Women with pelvic symptoms were younger, had less formal education, more frequent family history, and higher frequency and intensity of pelvic complaints. Mean ages at first symptom and diagnosis were lower in the pain group, but stage of endometriosis at first diagnosis was more advanced. The mean "diagnostic delay" was longer in the pelvic pain than in the infertile group (6.35 versus 3.13 years), but it decreased during three consecutive 5-year intervals in both groups, and there was also a gradual decrease in the frequency of advanced endometriosis at the time of first diagnosis.

Conclusions

Demographic and epidemiologic parameters in women with endometriosis differ, depending whether chronic pelvic pain or infertility are the presenting symptoms. In the pain group, diagnostic delay is longer and endometriosis at diagnostic laparoscopy more advanced, indicating progressiveness of the disease. During the last 15 years, diagnostic delay steadily decreased and the frequency of advanced endometriosis at first diagnosis declined.

Read the guide

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

Topics

Endometriosis › Diagnosis › Diagnostic Delay · General Gynecology › Pelvic Pain › Chronic Pelvic Pain

W. Paul Dmowski, Ryszard Lesniewicz, Nasiruddin Rana, Peg Pepping, Mojtaba Noursalehi

R Lesniewicz, N Rana, P Pepping, M Noursalehi

PMID 9022596 9022596 DOI 10.1016/S0015-0282(97)81904-8 10.1016/S0015-0282(97)81904-8 Dmowski et al. 1997, Dmowski 1997

Keywords

Adolescent, Adult, Chronic Disease, Endometriosis/complications/diagnosis, Female, Gynecology/trends, Humans, Infertility, Female/etiology, Laparoscopy, Pelvic Pain/etiology, Pelvis, Time Factors

Changing trends in the diagnosis of endometriosis: a comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility

At one clinic, endometriosis pain was diagnosed later than infertility

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

By this author

Related research

Keywords