VISIBLE AND NON-VISIBLE ENDOMETRIOSIS AT LAPAROSCOPY IN FERTILE AND INFERTILE WOMEN AND IN PATIENTS WITH CHRONIC PELVIC PAIN - A PROSPECTIVE-STUDY

In 100 consecutive patients who were undergoing laparoscopy for infert ility (group 1, n = 52), chronic pelvic pain (group 2, n = 18) or tuba l sterilization (group 3, n = 30, asymptomatic fertile women), periton eal biopsies were taken from areas of visually normal peritoneum of ut erosacral ligaments, Twenty-six patients in group 1 (50%), eight patie nts 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 appe arances 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 peritonea l lesions, Uterosacral biopsies showed the presence of endometriotic t issue 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 an d two of the three patients in group 3 had no evidence of endometriosi s at laparoscopy; thus histological study revealed the presence of end ometriosis in normal peritoneum in 11% (5/47) of patients having macro scopic endometriosis and in 6% (3/53) of patients without endometriosi s at laparoscopy, Previous oral contraceptive users were significantly higher among women having macroscopic and/or microscopic endometriosi s than among women without the condition, In conclusion, our prospecti ve study shows a high prevalence (45-50%) of endometriosis (including microscopic forms) in both patients with chromic pelvic pain and asymp tomatic women (fertile and infertile), thus supporting the modern conc ept that in many women endometriosis may be a paraphysiological condit ion while probably only in some patients small amounts of endometriosi s are an 'annoyance' with implications to their reproductive health an d may produce symptoms (e.g. pelvic pain) and therefore should be defi ned as a 'dis-ease'. Previous use of oral contraceptives may increase the risk of developing endometriosis.