Abstract
This research addresses a very important topic in the field of reproductive medicine: the relationship between endometriosis and infertility. In order to analyze the prevalence of infertility associated with endometriosis in the infertility clinic of the Santo Tomás Hospital during the year (2023), through the review of clinical records, extending a series of specific objectives that delve into Key aspects. We seek to estimate the most common age range among patients diagnosed with endometriosis, which not only gives us insight into the demographic distribution of this disease, but also suggests possible trends in its diagnosis. In addition, the aim is to determine the most frequent types of endometriosis in relation to age, which could reveal significant patterns in the reproductive history of women, potentially influencing their fertility prognoses. Finally, we will seek to understand the most commonly used treatments, which not only informs the population about the available therapeutic options, but also indicates where medical strategies and planning are headed in the fight against infertility associated with endometriosis. Thus, the importance of this research lies in its ability to offer a deep and up-to-date understanding of a complex medical problem that affects a significant number of women of reproductive age.
Keywords
Endometriosis, Infertility, Pregnancy, Treatment, Prevalence, Frequency
INTRODUCTION
Endometriosis is a benign, estrogen-dependent inflammatory disease characterized by the presence of ectopic endometrial glands and stroma, usually accompanied by fibrosis, at a site other than the uterine cavity. The main theories regarding its pathogenesis involve retrograde menstruation, germinal epithelium metaplasia, stem cells, altered immunity, metastatic dissemination, and genetic origins.(1,2)
The lesions are typically located in the pelvis; in the ovaries, uterosacral ligaments, and pouch of Douglas; however, they may also be found outside of it. It is a relatively common and potentially debilitating condition that primarily affects women of reproductive age. It ranks among the most complex gynecological disorders to manage given its association with pelvic pain and infertility, its insidious onset, surgical diagnosis, and often progressive nature.(3)
The disease causes a varied clinical picture that involves a classic triad of endometriosis symptoms: dysmenorrhea (pelvic or abdominal pain that appears before or during menstruation)(4), dyspareunia (pain during intercourse or other sexual activity)(5), and dyschezia (defecation disorder);(6) in addition to pelvic pain and infertility, they raise clinical suspicion of this disorder. However, the substantial overlap of endometriosis symptoms with other conditions that cause pelvic pain, both gynecological and non-gynecological, combined with the limitation of pelvic examination for its detection, makes clinical diagnosis challenging and it can only be diagnosed by surgical procedures.(2,7)
This challenging nature of endometriosis, in part, stems from a still limited understanding of its pathophysiology. The relationship between the extent of the disease and the degree of symptoms, its effect on fertility, and its most appropriate treatment remain undetermined. Medical treatment is only symptomatic and not curative, while surgical treatment, despite being curative, presents variable recurrence rates.(2,7)
Assisted reproductive techniques significantly improve birth rates in cases of infertility associated with the disease.(8)
Theoretical Framework
Endometriosis requires a multidisciplinary approach for effective management. It is essential that women with endometriosis receive continuous follow-up with their healthcare team to control disease progression and/or recurrences, each of which requires an individual and appropriate treatment plan for the management of this chronic condition.
This single-center, closed prevalence study retrospectively analyzed clinical cases of patients with endometriosis and their relationship with the incidence of infertility at the Infertility Clinic of Hospital Santo Tomás during the year (2023), through the review of clinical records.
Past data were collected to evaluate the association between endometriosis and infertility in this specific context.
Regarding sample selection and size, a non-probabilistic sampling was carried out, with a sample size of 64 clinical records. The study universe being the clinical records of patients with a diagnosis of infertility associated with endometriosis who attended the infertility clinic of Hospital Santo Tomás in the period from January to December (2023).
Regarding the unit of analysis, it consisted of clinical records of female patients of fertile age, ranging from 18 to 45 years of age, with a diagnosis of infertility associated with endometriosis.
The inclusion criteria for this study were:
Clinical records of patients of childbearing age in an age range from 18 years to 44 years and 11 months, at the time of attendance at the infertility clinic of Santo Tomás Hospital.
Clinical records of patients of any ethnicity, social stratum, and origin.
Clinical records of patients treated in the period from January 2023 to December 2023 at the infertility clinic of Hospital Santo Tomás.
Clinical records of patients with a diagnosis of endometriosis and primary or secondary infertility.
Clinical records of patients whose records are in digital format.
The exclusion criteria were:
Clinical records of patients under 18 and over 45 years of age at the time of attendance at the infertility clinic of the Santo tomás hospital.
Clinical records of patients who have undergone total or radical hysterectomy, bilateral salpingectomy, and bilateral ovarian cystectomy.
METHODS
In the research process in the digital archives of the infertility clinic of Hospital Santo Tomás, data collection stands as a fundamental pillar for extracting valuable information and thoroughly understanding the complex web of factors surrounding the problem. This meticulous procedure requires a series of carefully structured steps.
First, a review will be conducted of the documentation available in the clinic's digital files. These records are maintained in the Electronic Health Information System (SEIS), and from there they will be collected. This initial step involves identifying and classifying in detail more patients who meet the necessary characteristics, according to the inclusion and exclusion criteria.
After patient selection, the data will be transcribed into a database created using Excel software, focusing on aspects such as the treatments administered, test results, and gynecological-obstetric history, with emphasis on the diagnosis and its evolution. The next phase requires careful organization of the collected data, from which the information will be extracted for subsequent analysis.
Finally, we will proceed to the analysis phase, in which statistical techniques and specialized tools will be applied to extract meaningful knowledge. In this case, through descriptive statistics, contingency tables, logistic regression analysis, and bar or pie charts, we will organize the data so that they can be presented as results.
We used the EPI INFO tool, an updated, specialized software program for generating results from a predetermined database.
Results
For the calculation of the prevalence of endometriosis, data on the presence and absence of the disease within the study group were collected.
To calculate the prevalence of endometriosis, data related to the presence and absence of endometriosis within the studied group were collected. The total number of positively diagnosed cases (64) was recorded and divided by the total number of patients who attended the Infertility Clinic of Hospital Santo Tomás (428) to calculate the prevalence of endometriosis in the study population and multiplied by 100.
CONFIRMED CASES | TOTAL CASES | PREVALENCE |
|---|---|---|
64 | 428 | 14% |
Source: clinical record files from the infertility clinic of Hospital Santo Tómas in the year (2023)
In Table 1, the prevalence of endometriosis was calculated at the Infertility Clinic of Hospital Santo Tomás using data collected during the period (2023). The results revealed a prevalence of 14%, indicating that approximately 14% of the studied population has been diagnosed with endometriosis at the time of data collection.
Within the systematic review and meta-analysis, the prevalence of endometriosis in women is estimated. Wherein the overall prevalence of endometriosis was 18 per 100 (9).
In Figure 2, the age variable was analyzed using the properties of means, employing concepts such as mean age, median, minimum age, maximum age, and mode.
Age | Obs | Mean | Min | Median | Max | Mode |
|---|---|---|---|---|---|---|
Age | 64 | 34.48 | 26.00 | 35.00 | 44.00 | 40.00 |
Source: clinical records files from the infertility clinic of Hospital Santo Tómas in the year (2023)
It is observed that the average age of the studied population is 34.4 years. This suggests that most patients are close to 34 years old. The median age is 35 years, suggesting that half of the patients are 35 years old or younger and the other half are older than 35 years. There is an 18-year difference in the age range of the patients, with the minimum age being 26 years and the maximum age being 44 years.
The modal age is 40 years, meaning that the most common age of patients treated at the Infertility Clinic of Hospital Santo Tomás with endometriosis is 40 years.
The Costa Rican Association of Legal Medicine and Related Disciplines estimates that endometriosis affects between 6-10 % of women of reproductive age and that the most common age of diagnosis is around 40 years; however, these data come from one cohort study conducted on women who attend family planning clinics.(10)
In Figure 3, 5 types of endometriosis are evaluated based on the SEIS platform, a tool used in the infertility clinic of Santo Tomás Hospital, where the clinical records of patients with a single type of endometriosis (Figure 6) and the clinical records of patients who presented more than a single type of endometriosis were reviewed, in a total of 64 clinical records. Studies have determined that the most common type of endometriosis is superficial peritoneal endometriosis, which represents approximately 80 % of all cases.(11)
This form of endometriosis involves endometrium-like tissue lesions that affect the peritoneal surface and may have multiple appearances. Although not a subtype, endometriosis found within the intestinal wall is termed intestinal endometriosis, mainly affecting the rectosigmoid area. Furthermore, endometriosis involving the detrusor muscle and/or the bladder epithelium is called bladder endometriosis.(11)
In the data collected from the clinical records of patients with endometriosis, it was observed that ovarian endometriosis was present in 26 clinical records, representing 40.6% of the total.
Uterine endometriosis was present in 21 clinical records, reflecting a percentage of 32.8% of the total; unspecified endometriosis, with a total of 7 clinical records and a percentage of 10.9%; pelvic floor endometriosis, with a total of 2 clinical records, corresponding to 3.1%; and endometriosis of the fallopian tube, corresponding to a total of 1 clinical record, with a percentage of 1.5%.
The second half of Figure 3 corresponds to mixed endometriosis from the total of 64 patients, in which ovarian and uterine endometriosis were recorded with a total of 4 clinical records and a percentage of 6.2%; ovarian and pelvic floor endometriosis, uterine and pelvic floor endometriosis, and ovarian, pelvic floor, and uterine endometriosis each had a total of 1 clinical record and a percentage of 1.5%, respectively, as detailed in Figure 3.
Diagnosis | Frequency | Percentage | Cumulative percentage | Exact 95% LCL | Exact 95% UCL |
|---|---|---|---|---|---|
1 | 26 | 40.63% | 40.63% | 28.51% | 53.63% |
2 | 21 | 32.81% | 73.44% | 21.59% | 45.69% |
3 | 7 | 10.94% | 84.38% | 4.51% | 21.25% |
4 | 1 | 1.56% | 85.94% | 0.04% | 8.40% |
5 | 2 | 3.13% | 89.06% | 0.38% | 10.84% |
6* | 4 | 6.25% | 95.31% | 1.73% | 15.24% |
7* | 1 | 1.56% | 96.88% | 0.04% | 8.40% |
8* | 1 | 1.56% | 98.44% | 0.04% | 8.40% |
9* | 1 | 1.56% | 100.00% | 0.04% | 8.40% |
Total | 64 | 100.00% | 100.00% | [empty cell] | [empty cell] |
Source: Archives of clinical records from the infertility clinic of Hospital Santo Tómas in the year (2023)
Figure 3 shows that the most frequent types of endometriosis in the patient records of those who attended the infertility clinic of Hospital Santo Tomás in 2023 were ovarian endometriosis and uterine endometriosis, together totaling 47 patient records out of the 64 evaluated in this study, representing 73.4% of the total.
The remaining 26.5% were distributed among the endometriosis that could not be determined, reflecting 10.9% of the remaining 26.5%, and to a much lesser extent, pelvic floor endometriosis, fallopian tube endometriosis, and mixed endometriosis, among which the ovarian and uterine type was the most frequent, with a total of 4 patient records and a percentage of 6.2% of the remaining 26.5%.
We describe the frequency of ages at which patients were diagnosed with endometriosis at the infertility clinic of Hospital Santo Tomás.
Figure 4 consists of 3 columns and 20 rows: in the left column, the age range of patients diagnosed with endometriosis was placed, ranging from 26 to 44 years. In the center column, the frequency of endometriosis is recorded in the age range of the previous column. In the right column, the frequency of endometriosis is estimated as a percentage in the age range of patients seen at the infertility clinic of Hospital Santo Tomás in 2023.
Age | Frequency | Percentage |
|---|---|---|
26 | 5 | 7.81% |
27 | 2 | 3.13% |
28 | 3 | 4.69% |
29 | 1 | 1.56% |
30 | 3 | 4.69% |
31 | 2 | 3.13% |
32 | 6 | 9.38% |
33 | 3 | 4.69% |
34 | 5 | 7.81% |
35 | 6 | 9.38% |
36 | 5 | 7.81% |
37 | 5 | 7.81% |
38 | 2 | 3.13% |
39 | 3 | 4.69% |
40 | 9 | 14.06% |
41 | 1 | 1.56% |
42 | 2 | 3.13% |
44 | 1 | 1.56% |
Total | 64 | 100.00% |
Source: clinical record archives of the infertility clinic of Hospital Santo Tómas in the year (2023)
Of 64 patients diagnosed with endometriosis in the period (2023) at the infertility clinic of Hospital Santo Tomás, 14.0% of them were 40 years old, representing the age most frequently diagnosed in this study; followed by a concurrence of 9.3% between ages 32 and 35. For ages 26, 34, 36, and 37, there was also an equal frequency of 7.8%, and for ages 28, 30, 33, and 39, they coincide in a frequency of 4.6%.
In contrast, those who were diagnosed with endometriosis less frequently were the ages of 27, 31, 38, and 42, with a percentage of 3.13%, and the patients with the lowest diagnostic frequency in our study were those aged 29, 41, and 44.
In the review published by Elsevier “Endometriosis: a long road” published in the year (2021), by the authors P. Carrillo, Martínez Zamora & F. Carmona Herrera, it was reported that the prevalence of endometriosis in women of fertile age is 5-10 %, and the peak incidence occurs mostly between 30 and 45 years of age. This latter finding coincides in our study with the age at which there was the highest frequency of endometriosis diagnoses.(12)
Figure 5 describes the frequency of pregnancies after the treatment administered following the diagnosis of endometriosis at the infertility clinic of Hospital Santo Tomás. The first column is determined by the number of pregnancies, with two numbers representing 0 and 1, and the second column shows the frequency of each of these two values.
Pregnancy | Frequency | Percentage |
|---|---|---|
0 | 62 | 96.88% |
1 | 2 | 3.13% |
Total | 64 | 100.00% |
Source: Archives of clinical records of the infertility clinic of Hospital Santo Tómas in the year (2023)
It is evident considering the first column when noting the number of pregnancies, which out of 0, has a frequency of 62% because there are 3.1% that have a frequency of 2 with only one (1) pregnancy; that is, only one was carried out.
In an article entitled: "Pregnancy rates and outcomes in women with endometriosis: A systematic review and meta-analysis" published in 2019, (authors: García, L., Martínez, A., & Pérez, E.) it was reported that the frequency and rates of pregnancies in women with endometriosis with medical assistance, such as in vitro fertilization (IVF) and other assisted reproductive techniques, They can be comparable to those of women without endometriosis by analyzing the results of different treatment approaches. (13)
The cross-tabulation between Age and Endometriosis Diagnoses (Figure 7) provides a comparative analysis of Endometriosis Types and the frequency of each endometriosis type by age. The age distribution at which patients were diagnosed with endometriosis at the Hospital Santo Tomás infertility clinic was described.
Table No. 6 consists of 3 columns and 20 rows: the left column presents the age range from 26 to 44 years. The center column records the frequency of endometriosis for each age range. The right column reports the frequency of endometriosis as a percentage for each age range among patients treated at the infertility clinic of Hospital Santo Tomás in the year (2023).
The first aspect described is the age distribution relative to the diagnosis. For Diagnosis 1, 26 clinical records were identified with this diagnosis. Ages 34 and 36 had the highest percentages, 15.3% each, followed by 11.5% for ages 26, 32, and 40. Next, ages 33 and 35 accounted for 7.6% each. Finally, ages 27, 28, 29, 38, and 39 each presented with 3.8%, completing the distribution for this diagnosis.
For diagnosis 2, of the 64 clinical records that received a diagnosis, 32.8% obtained this diagnosis, representing 21 patients. The highest percentage was at age 40, with 23.8%. The remainder of the total is 26.5%, and is divided among the other diagnoses as a whole.
Diagnoses 4, 7, 8, and 9 represent the smallest portion, with each accounting for just over 1%, together comprising 9.5% of the total of 64 patients.
In the first column of Figure 7, the following diagnoses are listed from 1 to 9:
It is interesting to note that studies on endometriosis by age and its specific location, that is, studies that relate the type of endometriosis and age, have not been many, since until recently endometriosis was associated with premenopausal age (5 years or so before the onset of menopause) and therefore all of them are encompassed under the umbrella of the same age range. That is why it is interesting that our study highlights a variability in age range according to the type of endometriosis.
In 1 article published in 1987, an age-related relationship of endometriosis types was already found, especially pelvic floor (number 5 in figure 6). The researchers determined that with increasing age, fewer women reported showing signs of pelvic endometriosis. This is striking in our study, where in the early years of reproductive age, no pelvic floor cases were reported.(14)
Diagnosis | Code |
|---|---|
Ovarian endometriosis | 1 |
Uterine endometriosis | 2 |
Unspecified endometriosis | 3 |
Fallopian tube endometriosis | 4 |
Pelvic floor endometriosis | 5 |
Ovary + uterus | 6 |
Ovary + pelvic floor | 7 |
Uterus + pelvic floor | 8 |
Ovary + uterus + pelvic floor | 9 |
Source: Ábrego, Alvarado, Barrios, Chong, Montero, Peralta, Riperto (2024)
Diagnosis | Age | Age | Age | Age | Age | Age | Age | Age | Age | Age | Age | Age | Age | Age | Age | Age | Age | Age | Age |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
[empty cell] | 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | 39 | 40 | 41 | 42 | 44 | Total |
1 | 3 11.54 % 60.00 % | 1 3.85 % 50.00 % | 1 3.85 % 33.33 % | 1 3.85 % 100.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 3 11.54 % 50.00 % | 2 7.69 % 66.67 % | 4 15.38 % 80.00 % | 2 7.69 % 33.33 % | 4 15.38 % 80.00 % | 0 0.00 % 0.00 % | 1 3.85 % 50.00 % | 1 3.85 % 33.33 % | 3 11.54 % 33.33 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 26 100.00 % 40.62 % |
2 | 2 9.52 % 40.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 4.76 % 33.33 % | 2 9.52 % 100.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 4 19.05 % 66.67 % | 0 0.00 % 0.00 % | 3 14.29 % 60.00 % | 0 0.00 % 0.00 % | 1 4.76 % 33.33 % | 5 23.81 % 55.56 % | 0 0.00 % 0.00 % | 2 9.52 % 100.00 % | 0 0.00 % 0.00 % | 21 100.00 % 32.81 % |
3 | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 14.29 % 33.33 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 14.29 % 16.67 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 14.29 % 20.00 % | 1 14.29 % 20.00 % | 0 0.00 % 0.00 % | 1 14.29 % 33.33 % | 1 14.29 % 11.11 % | 1 14.29 % 100.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 7 100.00 % 10.94 % |
4 | 0 0.00 % 0.00 % | 1 100.00 % 50.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 100.00 % 1.56 % |
5 | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 50.00 % 33.33 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 50.00 % 100.00 % | 2 100.00 % 3.12 % |
6 | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 25.00 % 33.33 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 25.00 % 16.67 % | 0 0.00 % 0.00 % | 1 25.00 % 20.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 25.00 % 20.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 4 100.00 % 6.25 % |
7 | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 100.00 % 16.67 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 100.00 % 1.56 % |
8 | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 100.00 % 33.33 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 100.00 % 1.56 % |
9 | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 100.00 % 50.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 0 0.00 % 0.00 % | 1 100.00 % 1.56 % |
Total | 5 7.81 % 100.00 % | 2 3.12 % 100.00 % | 3 4.69 % 100.00 % | 1 1.56 % 100.00 % | 3 4.69 % 100.00 % | 2 3.12 % 100.00 % | 6 9.38 % 100.00 % | 3 4.69 % 100.00 % | 5 7.81 % 100.00 % | 6 9.38 % 100.00 % | 5 7.81 % 100.00 % | 5 7.81 % 100.00 % | 2 3.12 % 100.00 % | 3 4.69 % 100.00 % | 9 14.06 % 100.00 % | 1 1.56 % 100.00 % | 2 3.12 % 100.00 % | 1 1.56 % 100.00 % | 64 100.00 % 100.00 % |
Source: Clinical records archives of the infertility clinic of Hospital Santo Tómas in the year (2023)
DISCUSSION
Endometriosis is a debilitating disease with features of chronic inflammation. Endometriosis appears to be one of the most common benign gynecological blooms in premenopausal women, with an estimated 10-15% of women of reproductive age suffering from pelvic endometriosis. (2)
The women who consulted the infertility clinic at Hospital Santo Tomás presented with variable clinical pictures of chronic pelvic pain associated with dysmenorrhea, dyspareunia, dyschezia, and infertility, which raised suspicion of this condition.
In this research, data from 64 patients diagnosed with endometriosis were analyzed through the review of clinical records versus the total of 428 who consulted the infertility clinic in the year (2023), resulting in a 14 % prevalence, indicating that approximately 14 % of the studied population has been diagnosed with endometriosis at the time of data collection.
The findings on the age/prevalence of endometriosis were varied and nonspecific, resulting in a higher incidence in the age groups of 22 - 44 years (Figure 2). The most frequent non-mixed endometriosis diagnosed in the infertility clinic was ovarian and uterine endometriosis. Together they totaled 47 patients out of the 64 evaluated in this study, reflecting 73.4% of the total.
The mixed endometriosis types most frequently diagnosed in the infertility clinic were the ovarian and uterine type, with a total of 4 patients and a percentage of 6.2% of the remaining 26.5% (Figure 3). On the other hand, other types of mixed endometriosis were diagnosed, for example: E. ovary + pelvic floor (1 case), E. uterus + pelvic floor (1 case), E. ovary + uterus + pelvic floor (1 case), with a sum of 4.6% of the total sample (Figure 3).
Although its definitive diagnosis continues to require surgical-histological confirmation, a suggestive clinical picture, complemented by advances in imaging studies, allows a reliable presumptive diagnosis that is considered sufficient to initiate treatment in most cases. Medical management of the disease, although not definitive, is highly varied and offers symptomatic relief to most patients with few or minimal side effects. Laparoscopy, in addition to its diagnostic utility, is curative in many cases and provides benefits in the management of infertility.(3)
CONCLUSIONS
The treatment of endometriosis depends on symptom severity, reproductive plans, the patient's age, medical history, and the side effect profiles of surgical and medical treatments. Pharmacological management of endometriosis has been proposed, including NSAIDs, combined hormonal contraceptives (CHC), aromatase inhibitors, progestogens, danazol, and GnRH agonists; however, a major challenge is the degree of economic investment available to each patient.(15)
Although pharmacological inhibition of ovulation and menstruation can control pain, it does not eradicate the lesions. Surgery is generally associated with pain relief, but its benefit is usually temporary. Medical treatment of infertility is ineffective, whereas laparoscopic removal of endometriotic lesions and adnexal adhesions moderately increases the chances of conception; in vitro fertilization is a valid alternative to surgery.(16)
Reconsidering the framing of endometriosis as a premenopausal disease is of critical importance today. In this study, we document how this pathology directly affects female fertility. This expands the age range in which the disease presents, as it can be present even postmenarche, very early in a patient's fertile life.(17)
This is a call to all healthcare providers to include endometriosis in the differential diagnosis of pelvic pain. Regardless of the patient's age, providers should evaluate and consider the possibility of endometrial tissue growth, which is associated with problems in conception, fertilization, and implantation (17).
AGRADECIMIENTO
We wish to express our most sincere gratitude to all the people who contributed to the development of this study. First, we thank Dr. Ruth de Leon, Head of the Infertility Clinic of Hospital Santo Tomás, for providing us with the essential tools for conducting this study.
We also thank the nursing and secretarial staff of the infertility clinic at Hospital Santo Tomás, specifically the graduate nurse Itzy González and the secretary Hilda Cardoze.
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Declarations
Funding
Ninguna.
Conflict of interest
Ninguna.
Authorship contributions
Conceptualization: Anlly Añez, Aura Barrios, Paola Peralta, Sebastián Riperto.
Data curation: Anlly Añez, Aura Barrios, Paola Peralta, Sebastián Riperto.
Formal analysis: Anlly Añez, Aura Barrios, Paola Peralta, Sebastián Riperto.
Writing – original draft: Anlly Añez, Aura Barrios, Paola Peralta, Sebastián Riperto.
Writing – review and editing: Anlly Añez, Aura Barrios, Paola Peralta, Sebastián Riperto.