EPIDEMIOLOGY OF ENDOMETRIOSIS

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Endometriosis is a puzzling disease with little known about its true prevalence, its distribution in the population, or its risk factors. It is thought to be a relatively common disease, however, with an estimated prevalence among women of reproductive age as high as 10%.90 Given this relatively high prevalence and that women with the disease may have severe pelvic pain and infertility, endometriosis poses a significant public health problem. It is the third leading cause of gynecologic hospitalizations in the United States and a leading cause of hysterectomy.84 In a cost analysis prepared by the US Army, endometriosis cost $2.6 million over a 6-year period for time lost to service because of surgical hospitalization alone.10 This is an underestimate of the cost in the general population because women generally are ineligible for active duty if they have severe symptomatic endometriosis, and time lost from work for unhospitalized sick days could not be accounted for. In a recent analysis45 of women who participated in the US Health Interview Survey, 50% of those reporting having endometriosis had stayed in bed all day because of their condition at some time in the past 12 months, with the average number of bed days being 17.8. Thus, this disease is costly in its effects on women's quality of life, the expense of medical care, and its economic impact in the workplace.

This article summarizes present knowledge about the epidemiology of endometriosis. In this article well-designed and well-controlled studies are emphasized.

Section snippets

Large Studies of Hospitalized or Surgical Cohorts

Endometriosis can be definitively diagnosed only during the course of pelvic surgery, usually laparoscopy or laparotomy. Therefore, most prevalence estimates have been made on the basis of such surgical populations and are therefore highly selective. Table 1 presents the results of a few large studies in which hospital discharge data or surgical records (usually from laparoscopy or laparotomy) were reviewed over a specified period. The earliest of these studies reported on the prevalence of

RISK FACTORS

Numerous studies related to the epidemiology of endometriosis have been published. Various risk factors for the disease examined in these studies include (1) sociodemographic characteristics21, 22, 68 such as age,2, 3, 4, 5, 13, 16, 17, 18, 22, 23, 24, 27, 35, 38, 40, 42, 44, 51, 54, 55, 56, 61, 65, 70, 73, 75, 76, 78, 80, 84, 85, 88 race,3, 5, 13, 16, 17, 32, 39, 44, 55, 60, 71, 73, 78, 84 socioeconomic status,1, 4, 5, 7, 44, 56, 68, 73, 78 education,13, 55, 59, 70, 71, 73, 75, 78 and marital

FUTURE DIRECTIONS

Our knowledge about the disease patterns and risk factors of endometriosis is hampered by our inability to diagnose the disease in the general population. To truly understand the epidemiology of endometriosis, population-based cohort studies must become feasible. With the advent of fine-needle laparoscopy, women with less severe symptomatology may be more likely to be diagnosed. Only with the development of a noninvasive biomarker of disease, however, will it be possible to truly study the

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    Address reprint requests to Brenda Eskenazi, PhD School of Public Health University of California 140 Warren Hall Berkeley, CA 94720–7360

    This work was supported by Grant Nos. R824761-01 from the Environmental Protection Agency, R01 ES07171-01 from the National Institutes of Health, and EA-M1977 from the Endometriosis Association.

    *

    From the School of Public Health, University of California, Berkeley, California

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