Examining the co-occurrence of endometriosis and polycystic ovarian syndrome

Karen C Schliep; Lina Ghabayen; May Shaaban; Felicity R Hughes; Anna Z Pollack; Joseph B Stanford; Kristy Allen Brady; Amber Kiser; C Matthew Peterson

doi:10.1016/j.xagr.2023.100259

Endometriosis Associated Conditions

Examining the co-occurrence of endometriosis and polycystic ovarian syndrome

Schliep KC, Ghabayen L, Shaaban M, Hughes FR, Pollack AZ, Stanford JB, Brady KA, Kiser A, Peterson CM

Published August 2023 AJOG Global Reports, 3(3), 100259

DOI 10.1016/j.xagr.2023.100259 PMID 37663310 PMC PMC10472311

RRM Academy Synopsis

Endometriosis and PCOS co-occurred in nearly 1 in 20 surgical patients

Among 473 women having pelvic surgery, 5 out of 100 had both endometriosis and PCOS. In a matched group of 127 community women, 2 out of 100 did. The Utah and California cohort counted polyendocrine metabolic ovarian syndrome (PMOS), formerly PCOS, by diagnosis or symptoms.

Key Findings

In the operative cohort of 473 women, 35% had endometriosis only, 9% had PCOS only, and 5% had both.
In the population cohort of 127 women, 10% had endometriosis only, 8% had PCOS only, and 2% had both.
In the operative cohort, subfertility history had an adjusted prevalence ratio of 10.33 (95% CI 3.94-27.08) for both conditions, 2.45 (1.56-3.84) for endometriosis only, and 1.15 (0.51-2.61) for PCOS only.
In the operative cohort, chronic pelvic pain in the past 12 months was linked to having both conditions (adjusted prevalence ratio 2.53; 95% CI 1.07-6.00).

Interpretation

This cohort study followed 473 women who had pelvic surgery and 127 women from the same community. Women with both endometriosis and PCOS were ten times as likely to have a history of trouble getting pregnant as women with neither condition. Chronic pelvic pain was also linked to having both conditions. The authors note that PCOS status came from doctor diagnosis and symptom reports. Lab testing was not used, so some cases may have been missed. The findings support larger studies using gold-standard PCOS diagnosis to measure this overlap more precisely.

RRM Context

Restorative reproductive medicine looks for what is keeping a couple from getting pregnant. The field does not bypass that question. The authors suggest endometriosis may be a contributing factor when women with PCOS stay infertile after ovulation is restored. This is the kind of root-cause lead a restorative evaluation is built to find.

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

Abstract

Background

Polycystic ovarian syndrome and endometriosis are 2 of the most common reproductive disorders among women but are thought to be unrelated.

Objective

This study aimed to examine the overlap and common symptoms of polycystic ovarian syndrome and endometriosis.

Study Design

The study population included the Endometriosis, Natural History, Diagnosis, and Outcomes Study (2007-2009) operative cohort: 473 women, aged 18 to 44 years, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy at 1 of 14 surgical centers located in Salt Lake City, Utah, or San Francisco, California, in addition to a population cohort composed of 127 women from the surgical centers' catchment areas. Age and site-adjusted multinomial regression models were used to estimate adjusted prevalence ratios and 95% confidence intervals of reproductive history characteristics among women with endometriosis only, women with polycystic ovarian syndrome only, and women with both endometriosis and polycystic ovarian syndrome.

Results

Among the operative cohort, 35% had endometriosis only, 9% had polycystic ovarian syndrome only, and 5% had endometriosis and polycystic ovarian syndrome. Among the population cohort, 10% had endometriosis only, 8% had polycystic ovarian syndrome only, and 2% had endometriosis and polycystic ovarian syndrome. In the operative cohort, a history of subfertility was associated with a higher adjusted probability of having both conditions (adjusted prevalence ratio, 10.33; 95% confidence interval, 3.94-27.08), followed by having endometriosis only (adjusted prevalence ratio, 2.45; 95% confidence interval, 1.56-3.84) or polycystic ovarian syndrome only (adjusted prevalence ratio, 1.15; 95% confidence interval, 0.51-2.61), than having neither condition. In addition, experiencing chronic pelvic pain within the past 12 months was associated with a higher probability of having both conditions (adjusted prevalence ratio, 2.53; 95% confidence interval, 1.07-6.00) than having neither condition.

Conclusion

Among a cohort of women undergoing gynecologic laparoscopy or laparotomy, our study found that nearly 1 in 20 women had both an incident endometriosis diagnosis and symptoms consistent with polycystic ovarian syndrome. Among a population cohort of women not seeking gynecologic care, polycystic ovarian syndrome and endometriosis overlap prevalence was approximately 1 in 50 women.

Read the guide

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

Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.

22 min read

Topics

Endometriosis › Associated Conditions › Comorbid Conditions · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances

Karen C Schliep, Lina Ghabayen, May Shaaban, Felicity R Hughes, Anna Z Pollack, Joseph B Stanford, Kristy Allen Brady, Amber Kiser, C Matthew Peterson

K Schliep, L Ghabayen, M Shaaban, F Hughes, A Pollack, Joe Stanford, Joey Stanford, J Stanford, K Brady, A Kiser

PMID 37663310 37663310 DOI 10.1016/j.xagr.2023.100259 10.1016/j.xagr.2023.100259 Schliep et al. 2023, Schliep 2023

Examining the co-occurrence of endometriosis and polycystic ovarian syndrome

Endometriosis and PCOS co-occurred in nearly 1 in 20 surgical patients

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

By this author

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