Does asymptomatic endometriosis become symptomatic?

Abstract

Objective: Endometriosis is frequently found in women without any symptoms. It is not known if the presence of asymptomatic endometriosis with time will cause symptoms such as pain and need of an operation. From 1986 to 1989 a prospective study was performed at the University Hospital of Trondheim to look for endometriosis in healthy women undergoing tubal sterilisation. Endometriosis was disclosed in 20% of the women. The aim of the present study was to see if these women in the meantime had developed symptoms associated with endometriosis. Design: A follow-up case-control study comparing women harbouring asymptomatic endometriosis with women without endometriosis. Materials/Methods: Cases consists of 39 women with endometriosis diagnosed in connection with sterilisation in 1986–89. Controls consists of 157 women investigated in the same period and found free of endometriosis. In 2001 the women were sent a written questionnaire asking about pelvic pain, operations, menopausal status and use of hormone replacement therapy (HRT). Three women were lost to follow-up and four had died. Results: Endometriosis was initially at sterilisation found in 39 patients whereas 157 did not show any signs of endometriosis. Their age was then 37.1 respectively 36.5 years. Response was obtained from 32 (82%) and 120 (80%). Their present age was now 50.3 versus 49.9 years. Seventeen (53%) respectively 76 (63%) were postmenopausal. Among women menstruating spontaneously or because of HRT, 27% versus 23% had dysmenorrhoea, and 67% versus 43% had premenstrual pain. Pelvic pain had a prevalence of 6% versus 19%, and 16% respectively 13% had been investigated for this symptom. Hysterectomy for benign conditions was performed in 19% of the women with endometriosis and in 8% of the women without endometriosis. In addition two of the women without endometriosis were hysterectomised due to malignancy. None of these differences were statistically significant. Conclusions: This study with a mean observation time of 13 years shows that women presenting with asymptomatic endometriosis do not develop pelvic pain more frequently than women without. The hysterectomy rate for benign disorders was however more than doubled for women with endometriosis. This difference did not reach statistical significant which maybe could be explained by the limited number of patients. Supported By: No support.