Epidemiology

Epidemiologic factors have been extrapolated primarily from cohorts of women with pelvic pain and infertility, which complicate the assessment of prevalence. It is generally accepted that up to 10% of reproductive-aged women are affected by endometriosis.[3][4][5] Endometriosis is most commonly diagnosed between the ages of 18 and 29 years.[5] Women with a first-degree relative with endometriosis have a 7- to 10-fold increased risk of having it themselves.[6][7] Genetic predisposition to the disease has been well documented in sibling pair studies.[8][9]​​

Documentation of endometriosis requires a more thorough examination than may be performed during procedures with indications other than pelvic pain. A study that assessed pathologic specimens from women undergoing vaginal hysterectomy for chronic pelvic pain documented a rate of endometriosis of 8.3%.[10] Higher estimates may be seen in cohorts undergoing laparoscopy for pelvic pain (12% to 70%) or infertility (9% to 50%), especially in adolescent populations who have chronic pain refractory to medical management.[11][12][13] Such a large range of estimates may be explained by heterogeneity in study design with more recent studies including diagnostic criteria not previously established.[12] Global trends of disease are even less reliable due to the reliance on surgical findings as confirmation of disease and the inconsistent documentation of pelvic pain in the literature.[14] An epidemiological assessment from the ENDO Study Working Group provided estimates of prevalence based on operative findings as well as magnetic resonance imaging, suggesting that endometriosis may be more prevalent than previously reported, with a strong association with infertility.[15]

Endometriosis typically affects women of reproductive age, but a wide spectrum of age at diagnosis exists.[4] Contrary to previous paradigms, premenarcheal girls presenting with chronic pelvic pain should be evaluated for endometriosis as this condition has been reported in this young cohort.[16] Adolescents who complain of moderate-to-severe dysmenorrhea since menarche and whose complaints progress and become more acyclic may have endometriosis. This group is often overlooked.[1][17] Furthermore, endometriosis can present in menopausal women.[2]​​

The prevalence is thought to be higher in white women and in those with a lower body mass index.[11][18]

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