Can We Predict the Coexistence of Endometriosis in Patients with Symptomatic Fibroids?

Abstract

Study ObjectiveTo investigate the coexistence of endometriosis in women presenting with symptomatic fibroids.DesignRetrospective review from May 2005 until April 2012.SettingUniversity affiliated tertiary referral center.Patients545 consecutive patients who underwent surgery for their fibroids, which at minimum allowed assessment of their pelvis for endometriosis. Patients with a previously established diagnosis of endometriosis (n = 69), and those were menopausal (n = 15) were excluded.Intervention267 patients underwent a hysterectomy: 208 laparoscopic total, 55 laparoscopic subtotal, and 4 abdominal total. 194 patients underwent a myomectomy: 170 laparoscopic, 10 laparoscopic and hysteroscopic, and 14 hysteroscopic (along with a laparoscopy to diagnose and/or treat endometriosis).Measurements and Main ResultsThe average age of patients was 43 years (range 21 – 59), and their median parity was 0. Menorrhagia was the most common presenting complaint (present in 73.1%), with 38.6% being anemic, with an average hemoglobin level of 96 g/L. Forty nine percent of patients were diagnosed with concurrent endometriosis at the time of surgery. Patients with endometriosis were 1.2 years younger than those with fibroids alone (42.4 vs. 43.6 years, p = 0.049). They also had higher mean CA-125 levels (51.5 vs. 28.5 U/mL, p = 0.047), and were more likely to be nulliparous (p = 0.012), and present with pelvic pain (p = 0.039). Patients without endometriosis had larger fibroids on average (7.4 vs. 6.1 cm, p<0.001), and were more likely to present with mass symptoms (p<0.001).ConclusionGiven that approximately one-half of women presenting with symptomatic fibroids have co-existing endometriosis, it is advisable to include a discussion regarding endometriosis and its treatment during pre-operative counseling of all such patients. Study ObjectiveTo investigate the coexistence of endometriosis in women presenting with symptomatic fibroids. To investigate the coexistence of endometriosis in women presenting with symptomatic fibroids. DesignRetrospective review from May 2005 until April 2012. Retrospective review from May 2005 until April 2012. SettingUniversity affiliated tertiary referral center. University affiliated tertiary referral center. Patients545 consecutive patients who underwent surgery for their fibroids, which at minimum allowed assessment of their pelvis for endometriosis. Patients with a previously established diagnosis of endometriosis (n = 69), and those were menopausal (n = 15) were excluded. 545 consecutive patients who underwent surgery for their fibroids, which at minimum allowed assessment of their pelvis for endometriosis. Patients with a previously established diagnosis of endometriosis (n = 69), and those were menopausal (n = 15) were excluded. Intervention267 patients underwent a hysterectomy: 208 laparoscopic total, 55 laparoscopic subtotal, and 4 abdominal total. 194 patients underwent a myomectomy: 170 laparoscopic, 10 laparoscopic and hysteroscopic, and 14 hysteroscopic (along with a laparoscopy to diagnose and/or treat endometriosis). 267 patients underwent a hysterectomy: 208 laparoscopic total, 55 laparoscopic subtotal, and 4 abdominal total. 194 patients underwent a myomectomy: 170 laparoscopic, 10 laparoscopic and hysteroscopic, and 14 hysteroscopic (along with a laparoscopy to diagnose and/or treat endometriosis). Measurements and Main ResultsThe average age of patients was 43 years (range 21 – 59), and their median parity was 0. Menorrhagia was the most common presenting complaint (present in 73.1%), with 38.6% being anemic, with an average hemoglobin level of 96 g/L. Forty nine percent of patients were diagnosed with concurrent endometriosis at the time of surgery. Patients with endometriosis were 1.2 years younger than those with fibroids alone (42.4 vs. 43.6 years, p = 0.049). They also had higher mean CA-125 levels (51.5 vs. 28.5 U/mL, p = 0.047), and were more likely to be nulliparous (p = 0.012), and present with pelvic pain (p = 0.039). Patients without endometriosis had larger fibroids on average (7.4 vs. 6.1 cm, p<0.001), and were more likely to present with mass symptoms (p<0.001). The average age of patients was 43 years (range 21 – 59), and their median parity was 0. Menorrhagia was the most common presenting complaint (present in 73.1%), with 38.6% being anemic, with an average hemoglobin level of 96 g/L. Forty nine percent of patients were diagnosed with concurrent endometriosis at the time of surgery. Patients with endometriosis were 1.2 years younger than those with fibroids alone (42.4 vs. 43.6 years, p = 0.049). They also had higher mean CA-125 levels (51.5 vs. 28.5 U/mL, p = 0.047), and were more likely to be nulliparous (p = 0.012), and present with pelvic pain (p = 0.039). Patients without endometriosis had larger fibroids on average (7.4 vs. 6.1 cm, p<0.001), and were more likely to present with mass symptoms (p<0.001). ConclusionGiven that approximately one-half of women presenting with symptomatic fibroids have co-existing endometriosis, it is advisable to include a discussion regarding endometriosis and its treatment during pre-operative counseling of all such patients. Given that approximately one-half of women presenting with symptomatic fibroids have co-existing endometriosis, it is advisable to include a discussion regarding endometriosis and its treatment during pre-operative counseling of all such patients.