It is not all About Size. Incidence and Implications of Concurrent Endometriosis in Women Undergoing Laparoscopic Surgery for Fibroids

Abstract

Study Objective To assess the incidence and predictive factors associated with endometriosis co-occurrence in patients having surgery for fibroid pathology. Design Retrospective observational study of all premenopausal women who underwent fibroid surgery at the Centre for Advanced Reproductive Endosurgery in Sydney, Australia between October 2008 and December 2016. Setting A single center study from a high volume gynecological practice. Patients or Participants All premenopausal patients who underwent laparoscopic surgery (hysterectomy or myomectomy) who had histologically confirmed fibroids during the study period. Patients were identified from the database at the single pathology service where all surgical specimens were referred for histological analysis. Interventions Standardized demographic, clinical history, operative and pathological findings were collected from the electronic medical record. Descriptive statistics were used to describe baseline patient population characteristics as well as the prevalence of endometriosis and factors associated with higher co-occurrence of the two conditions. Measurements and Main Results 551 women were eligible for inclusion, with a median age of 43 years (range 21-59). 62.4% of the women had a prior pregnancy and 51.1% at least one delivery. 19.8% had previous endometriosis surgery. 61.5% had endometriosis that was identified and treated at the time of the fibroid operation. Factors significantly associated with endometriosis presence included a history of dysmenorrhea (OR 1.92, 95% CI 1.35 -2.72), dyschezia (OR 7.29, 95% CI 1.70 - 31.32) and subfertility (OR 4.44, 95% CI 2.45 – 8.06). Multivariate analysis was undertaken with the aim of establishing a predictive model based on symptomatology however only marginal additional predictive value was gained. Conclusion There is a significant co-occurrence of endometriosis amongst women undergoing fibroid surgery, particularly those with subfertility, dysmenorrhea and dyschezia. Clinical awareness of this co-occurrence is essential for adequate pre-operative patient counselling and strategic surgical planning for women presenting with fibroids. This is especially pertinent for those with subfertility or chronic pelvic pain where symptoms may persist if the endometriosis remains untreated.