PREVALENCE AND ANATOMICAL DISTRIBUTION OF ENDOMETRIOSIS IN WOMEN WITHSELECTED GYNECOLOGICAL CONDITIONS - RESULTS FROM A MULTICENTRIC ITALIAN STUDY

We have evaluated the prevalence of endometriosis in selected gynaecol ogical conditions requiring surgery. Eligible for the study were women with primary or secondary sterility, chronic pelvic pain, fibroids or benign ovarian cysts requiring laparoscopy or laparotomy consecutivel y observed during the study period in 23 obstetrics and gynaecology de partments in Italy between May 1991 and July 1992. Women with a previo us diagnosis of endometriosis were specifically excluded. A total of 3 684 subjects entered the study. Of these, 660 (mean age 31 years) were included for sterility, 409 (mean age 32) for chronic pelvic pain, 18 80 (mean age 42) for fibroids and 735 (mean age 33) for benign ovarian cysts. During the surgical procedure surgeons were asked to examine t he pelvis carefully to identify endometriosis. Out of the 660 women in cluded for sterility, 195 [30%, 95% confidence interval (CI) 26-35] ha d endometriosis; the corresponding figures were 185 out of 409 (45%, 9 5% CI 39-52) for pelvic pain, 219 out of 1880 (12%, 95% CI 10-14) for fibroids and 257 out of 735 (35%, 95% CI 31-40) for ovarian cysts; the se differences were significant (x(3)(2) heterogeneity, absence versus presence = 323.9, P < 0.001). Among women with endometriosis who ente red the study for sterility, 51% were at stage 1, 22% at stage 2, 20% at stage 3 and 7% at stage 4. The corresponding figures for pelvic pai n and fibroids were largely similar: 37%, 24%, 30%, 10% for women with pelvic pain, 36%, 11%, 45% and 8% for those with fibroids, but among cases with ovarian cysts stage 3 was over-represented (62% of cases). The most common sites of endometriosis were, in order of frequency, th e ovaries considered together, the posterior cul de sac and uterosacra l ligaments. Endometriotic implants were more common on the uterosacra l ligaments and the posterior cul de sac among women with sterility an d pelvic pain than in those with fibroids and ovarian cysts. The frequ ency of endometriosis was not directly related to age at surgery, but decreased with increasing parity in all the four criteria for entry gr oups.