Page 13 - Diagnostic delay of endometriosis
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Epidemiology
As stated before, the estimated prevalence rate of endometriosis is 10% in the general female population. A wide variety in prevalence is seen in different studies, which may be influenced by the type of study population or the diagnostic criteria applied.2, 3, 20, 22-24 The high estimates are derived from a selection of women undergoing laparoscopic tubal ligation, and include women with asymptomatic endometriotic lesions that did not require treatment.5 On the other hand, literature from the general population reported relatively low prevalence rates.22, 25 These studies rely on completeness of coding in medical records or databases, and potentially exclude asymptomatic women or those with only mild to moderate symptoms who did not receive full diagnostic tests or treatment, as well as women with limited access to healthcare, for instance because of low socio-economic status and lack of insurance. Moreover, many women with symptoms suggestive of endometriosis either receive a false diagnosis, for instance irritable bowel disease, or respond well to pragmatic medical treatment and may not proceed towards diagnostic or therapeutic laparoscopy, and therefore do not have a confirmed diagnosis which hampers the accuracy of administrative studies.
Endometriosis is seen predominantly in women of reproductive age. There appears to be a peak in diagnosis between age 25 and 35 years old.22, 24, 26 Risk factors are prolonged or extensive exposure to menstrual flow, the presence of Müllerian duct anomalies and cervical or vaginal obstruction, and a positive family history. 18, 20, 27 There is no convincing evidence that prevalence rates vary with race or ethnicity. Early studies suggested that endometriosis is infrequent in Black women as well as those of low socio- economic status, but they are likely to be influenced by methodological and social bias, and may reflect a limited ability to access healthcare, in particular advanced and expensive diagnostic or therapeutic regimens.28
Types of endometriosis
Three distinct clinical forms of pelvic endometriosis can be distinguished: peritoneal, ovarian and deep endometriosis (figure). Peritoneal endometriosis is defined as the presence of characteristic superficial implants on the pelvic peritoneum. The peritoneal lesions can only be visualized at laparoscopy and may have many variable appearances. They can provoke an inflammatory response and cause adhesions in the abdominal cavity. Ovarian endometriosis
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