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 laparoscopyfor infertility (group 1, n = 52), chronic pelvic pain (group2, n = 18) or tubal sterilization (group 3, n = 30, asymptomaticfertile women), peritoneal biopsies were taken from areas ofvisually normal peritoneum of uterosacral ligaments. Twenty-sixpatients in group 1 (50%), eight patients in group 2 (44.4%)and 13 patients in group 3 (43.3%), were found to have laparoscopicevidence of endometriosis elsewhere in the pelvis. The majorityof women (80.7% in group 1, 87.5% in group 2, and 100% in group3) had stage I disease. The incidence of the distinctive appearancesof the lesions was similar in the three groups of patients and7% of all women or 15% (7/47) of those patients having endometriosisat laparoscopy had only subtle (non-‘typical’) endometrioticperitoneal lesions. Uterosacral biopsies showed the presenceof endometriotic tissue in three cases (5.7%), two cases (11%)and three cases (10%) in groups 1, 2, and 3 respectively. Oneof the two patients in group 2 and two of the three patientsin group 3 had no evidence of endometriosis at laparoscopy;thus histological study revealed the presence of endometriosisin normal peritoneum hi 11 % (5/47) of patients having macroscopicendometriosis and hi 6% (3/53) of patients without endometriosisat laparoscopy. Previous oral contraceptive users were significantlyhigher among women having macroscopic and/or microscopic endometriosisthan among women without the condition. In conclusion, our prospectivestudy shows a high prevalence (45–50%) of endometriosis(including microscopic forms) in both patients with chronicpelvic pain and asymptomatic women (fertile and infertile),thus supporting the modern concept that in many women endometriosismay be a paraphysiological condition while probably only hisome patients small amounts of endometriosis are an ‘annoyance’with implications to their reproductive health and may producesymptoms (eg. pelvic pain) and therefore should be defined asa ‘dis-ease’. Previous use of oral contraceptivesmay increase the risk of developing endometriosis.