Abstract
There is still much controversy regarding the epidemiology of endometriosis. The objective of this work is to conduct a systematic review, and if possible, proceed with a meta-analysis of studies that have analyzed the incidence and prevalence of this condition among women in the general population. The inclusion criteria were papers published after 1997 that had reported data of the incidence or prevalence of endometriosis. The PubMed search engine was used to identify papers meeting the inclusion criteria from 1997 to 2019, with an additional manual search for the identification of potentially eligible studies. The search was limited to papers published in English. The risk of bias was assessed according to the Joanna Briggs Institute Critical Appraisal Checklist. As a result, 27 papers, which included a total of 28,660,652 women, were classified according to the type of design and sources of information in five subgroups. Pooled estimates of prevalence for studies with self-reported data were 0.05 (95% CI: 0.03; 0.06), 0.01 for population-based integrated information systems (95% CI: 0.01; 0.02), and 0.04 (95% CI 0.04; 0.05) in studies using other designs. The pooled incidence rate of endometriosis was: 1.36 per 1000 person-years (PY) (95% CI: 1.09; 1.63) for studies based on hospital discharges, 3.53 per 1000 PY (95% CI: 2.06; 4.99) for cohort studies, and 1.89 per 1000 PY (95% CI: 1.42; 2.37) for population-based integrated information systems. Meta-analysis indicated high heterogeneity based on I-squared statistics. This significant variability may not only be due to methodological issues and the specific limitations of the different designs and data analyzed, including case definitions and subject selection strategies, but also to the inherent heterogeneity of endometriosis. Epidemiological studies with appropriate study designs remain necessary to provide a valid estimation of the population burden of endometriosis.
Highlights
Endometriosis is a complex clinical condition [1] characterized by the growth of endometrial-like tissue, glands, and stroma outside of the uterine cavity
The inclusion criteria for this systematic review were papers published after the Eskenazi paper through 31/8/2019 that had reported data of the incidence or prevalence of endometriosis, referring to the general population, published in English [2]
This work is the first review of the literature to systematically collect the evidence, obtain pooled estimates on the incidence and prevalence of endometriosis in general populations, and assess the strengths and limitations of the different data, methods, and case definitions
Summary
Endometriosis is a complex clinical condition [1] characterized by the growth of endometrial-like tissue, glands, and stroma outside of the uterine cavity. Despite extensive research commencing 160 years ago [3], there remain much controversy and dilemmas regarding this complex and enigmatic disorder, related to its etiopathogenesis, diagnosis, overall clinical management, prognosis, and the epidemiology of this condition. Multiple authors have pursued to clarify the epidemiology of endometriosis. Those publications used significantly different data sources and designs and were based on different definitions of an endometriosis case. The objective of this paper is to provide a systematic assessment of the existing evidence regarding the incidence and prevalence of endometriosis and, if possible, quantify the available evidence through a meta-analysis and provide a critical assessment of the advantages and limitations of the different methodological approaches and case definitions
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