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Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study.

Abstract

In 100 consecutive patients who were undergoing laparoscopy for infertility (group 1, n = 52), chronic pelvic pain (group 2, n = 18) or tubal sterilization (group 3, n = 30, asymptomatic fertile women), peritoneal biopsies were taken from areas of visually normal peritoneum of uterosacral ligaments. Twenty-six patients in group 1 (50%), eight patients in group 2 (44.4%) and 13 patients in group 3 (43.3%), were found to have laparoscopic evidence of endometriosis elsewhere in the pelvis. The majority of women (80.7% in group 1, 87.5% in group 2, and 100% in group 3) had stage I disease. The incidence of the distinctive appearances of the lesions was similar in the three groups of patients and 7% of all women or 15% (7/47) of those patients having endometriosis at laparoscopy had only subtle (non-¿typical') endometriotic peritoneal lesions. Uterosacral biopsies showed the presence of endometriotic tissue in three cases (5.7%), two cases (11%) and three cases (10%) in groups 1, 2, and 3 respectively. One of the two patients in group 2 and two of the three patients in group 3 had no evidence of endometriosis at laparoscopy; thus histological study revealed the presence of endometriosis in normal peritoneum in 11% (5/47) of patients having macroscopic endometriosis and in 6% (3/53) of patients without endometriosis at laparoscopy. Previous oral contraceptive users were significantly higher among women having macroscopic and/or microscopic endometriosis than among women without the condition. In conclusion, our prospective study shows a high prevalence (45-50%) of endometriosis (including microscopic forms) in both patients with chronic pelvic pain and asymptomatic women (fertile and infertile), thus supporting the modern concept that in many women endometriosis may be a paraphysiological condition while probably only in some patients small amounts of endometriosis are an ¿annoyance' with implications to their reproductive health and may produce symptoms (e.g. pelvic pain) and therefore should be defined as a ¿dis-ease'. Previous use of oral contraceptives may increase the risk of developing endometriosis.

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  • Authors+Show Affiliations

    ,

    Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Barcelona, Hospital Clínic i Provincial, Spain.

    , , , , ,

    Source

    Human reproduction (Oxford, England) 11:2 1996 Feb pg 387-91

    MeSH

    Adult
    Biopsy
    Chronic Disease
    Contraceptives, Oral
    Endometriosis
    Female
    Humans
    Infertility, Female
    Laparoscopy
    Pelvic Pain
    Prospective Studies
    Reference Values

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    8671229

    Citation

    Balasch, J, et al. "Visible and Non-visible Endometriosis at Laparoscopy in Fertile and Infertile Women and in Patients With Chronic Pelvic Pain: a Prospective Study." Human Reproduction (Oxford, England), vol. 11, no. 2, 1996, pp. 387-91.
    Balasch J, Creus M, Fábregues F, et al. Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. Hum Reprod. 1996;11(2):387-91.
    Balasch, J., Creus, M., Fábregues, F., Carmona, F., Ordi, J., Martinez-Román, S., & Vanrell, J. A. (1996). Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. Human Reproduction (Oxford, England), 11(2), pp. 387-91.
    Balasch J, et al. Visible and Non-visible Endometriosis at Laparoscopy in Fertile and Infertile Women and in Patients With Chronic Pelvic Pain: a Prospective Study. Hum Reprod. 1996;11(2):387-91. PubMed PMID: 8671229.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. AU - Balasch,J, AU - Creus,M, AU - Fábregues,F, AU - Carmona,F, AU - Ordi,J, AU - Martinez-Román,S, AU - Vanrell,J A, PY - 1996/2/1/pubmed PY - 1996/2/1/medline PY - 1996/2/1/entrez SP - 387 EP - 91 JF - Human reproduction (Oxford, England) JO - Hum. Reprod. VL - 11 IS - 2 N2 - In 100 consecutive patients who were undergoing laparoscopy for infertility (group 1, n = 52), chronic pelvic pain (group 2, n = 18) or tubal sterilization (group 3, n = 30, asymptomatic fertile women), peritoneal biopsies were taken from areas of visually normal peritoneum of uterosacral ligaments. Twenty-six patients in group 1 (50%), eight patients in group 2 (44.4%) and 13 patients in group 3 (43.3%), were found to have laparoscopic evidence of endometriosis elsewhere in the pelvis. The majority of women (80.7% in group 1, 87.5% in group 2, and 100% in group 3) had stage I disease. The incidence of the distinctive appearances of the lesions was similar in the three groups of patients and 7% of all women or 15% (7/47) of those patients having endometriosis at laparoscopy had only subtle (non-¿typical') endometriotic peritoneal lesions. Uterosacral biopsies showed the presence of endometriotic tissue in three cases (5.7%), two cases (11%) and three cases (10%) in groups 1, 2, and 3 respectively. One of the two patients in group 2 and two of the three patients in group 3 had no evidence of endometriosis at laparoscopy; thus histological study revealed the presence of endometriosis in normal peritoneum in 11% (5/47) of patients having macroscopic endometriosis and in 6% (3/53) of patients without endometriosis at laparoscopy. Previous oral contraceptive users were significantly higher among women having macroscopic and/or microscopic endometriosis than among women without the condition. In conclusion, our prospective study shows a high prevalence (45-50%) of endometriosis (including microscopic forms) in both patients with chronic pelvic pain and asymptomatic women (fertile and infertile), thus supporting the modern concept that in many women endometriosis may be a paraphysiological condition while probably only in some patients small amounts of endometriosis are an ¿annoyance' with implications to their reproductive health and may produce symptoms (e.g. pelvic pain) and therefore should be defined as a ¿dis-ease'. Previous use of oral contraceptives may increase the risk of developing endometriosis. SN - 0268-1161 UR - https://www.unboundmedicine.com/medline/citation/8671229/full_citation L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/11.2.387 DB - PRIME DP - Unbound Medicine ER -