LAPAROSCOPIC EVALUATION OF THE ONSET AND PROGRESSION OF ENDOMETRIOSIS

OBJECTIVE: To clarify the pathogenesis of endometriosis on the basis o f analysis of primary lesion sites, age at onset, rate of progression, and response to drug treatment. STUDY DESIGN: The clinical records of 690 women with laparoscopically confirmed endometriosis were retrospe ctively analyzed based on the revised American Fertility Society point system. RESULTS: The primary site of endometriosis was the uterosacra l ligament and pelvic peritoneum/pouch of Douglas in 73% of patients w ith stage I disease, whereas only 16% had ovarian lesions. However, di sease progression was associated with an increasing frequency of ovari an lesions. In terms of the revised American Fertility Society score, endometriosis progressed at a mean rate of 0.3 point per month. Thus t he earliest onset of endometriosis was estimated at 3 to 4 years after menarche. Drug therapy improved the revised American Fertility Societ y score by about 50%. Patients with a low response to an initial cycle of therapy generally showed further improvement after an additional t reatment cycle. CONCLUSIONS: Because endometriosis may occur as early as 3 to 4 years after menarche and gradually progresses, drug therapy, including long-term treatment, should be carried out in women with de finitive evidence of endometriosis who must maintain their reproductiv e potential.