Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain

Philippe R. Koninckx; Christel Meuleman; Stephan Demeyere; Emmanuel Lesaffre; Freddy J. Cornillie

doi:10.1016/s0015-0282(16)54244-7

Endometriosis Diagnosis

Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain

Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ

Published April 1991 Fertility and Sterility, 55(4), 759-765

DOI 10.1016/s0015-0282(16)54244-7 PMID 2010001

RRM Academy Synopsis

Deeper endometriosis lesions go with pelvic pain and older age

A three-year prospective series at one Belgian university hospital covered 643 consecutive surgeries for infertility, pain, or both. Lesions deeper than 6 mm turned up in about 2 out of 10 women with pain. About 1 out of 10 women with infertility had them. In this group, deep lesions were more common in older women.

Key Findings

Surgeons saw endometriosis in 68% of women operated on for infertility (n = 416), 71% for pelvic pain (n = 170), and 84% for both (n = 57).
Among women with infertility, pain, or both, 9%, 24%, and 38% respectively had lesions deeper than 6 mm (P < 0.001).
After correcting for the reason for surgery, subtle lesions became less frequent with age, typical lesions and endometriomas more frequent, and depth over 6 mm increased (P = 0.02).
Pain correlated with the depth of the deepest lesion (P < 0.0001). Once depth was accounted for, pelvic area, volume, and endometriomas no longer contributed significantly.
In the four stage classes of the revised American Fertility Society system, 3%, 34%, 15%, and 22% of women had lesions deeper than 6 mm.

Interpretation

This prospective cohort study followed 643 surgeries for infertility, pelvic pain, or both at a university hospital. Pain tracked closely with how deep the lesions went. Deeper lesions meant more pain. The authors say deep lesions are the main cause of that pain, though they do not yet know why. Deep lesions also became more common with age. The pattern held no matter why the surgery was done. The authors note that women sent to a university hospital are not a typical group, so rates here may run higher than in women overall. The findings support larger studies that track lesion depth over time and its link to fertility.

RRM Context

Restorative reproductive medicine looks for the root cause of pain. Excision is the surgical standard for endometriosis. The surgeons in this study measured lesion depth during excision, the same approach a restorative evaluation uses. Lesions over 6 mm deep showed up in 3% of women at the lowest stage and 34% at the next stage. Stage told little about depth. This fits the restorative principle that stage does not equal how bad the symptoms are.

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

Abstract

In a 3-year prospective study of 643 consecutive laparoscopies for infertility, pelvic pain, or infertility and pain, the pelvic area, the depth of infiltration, and the volume of endometriotic lesions were evaluated. The incidence, area, and volume of subtle lesions decreased with age, whereas for typical lesions these parameters and the depth of infiltration increased with age. Deeply infiltrating endometriosis was strongly associated with pelvic pain, women with pain having larger and deeper lesions. Because deep endometriosis has little emphasis in the revised American Fertility Society classification and after analyzing the diagnoses made in each class, considerations for a simplifying revision with inclusion of deep lesions are suggested. In conclusion, suggestive evidence is presented to support the concept that endometriosis is a progressive disorder, and it is demonstrated that deep endometriosis is strongly associated with pelvic pain.

Responses

Endometriosis: will the real natural history please stand up?

Redwine DB, 1991

Are the basic assumptions correct--is endometriosis a progressive, self-destructive disease?

Redwine DB, 2001

Read the guide

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

Topics

Endometriosis › Diagnosis › Staging and Classification · General Gynecology › Pelvic Pain › Chronic Pelvic Pain · Clinical Guidelines and Standards › Diagnostic Criteria and Classification › Staging and Classification Systems

Philippe R. Koninckx, Christel Meuleman, Stephan Demeyere, Emmanuel Lesaffre, Freddy J. Cornillie

P Koninckx, C Meuleman, S Demeyere, E Lesaffre, F Cornillie

PMID 2010001 2010001 DOI 10.1016/s0015-0282(16)54244-7 10.1016/s0015-0282(16)54244-7 Koninckx et al. 1991, Koninckx 1991

Keywords

Aging/physiology, Dyspareunia/etiology, Endometriosis/complications/physiopathology, Female, Humans, Menstruation Disturbances/etiology, Neoplasm Invasiveness, Pain, Pelvis, Prospective Studies

Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain

Deeper endometriosis lesions go with pelvic pain and older age

Key Findings

Interpretation

RRM Context

Abstract

Responses

Read the guide

Topics

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Keywords