Endometriosis by Race

There is limited evidence of information that diverse populations by race and ethnicity pose a risk for endometriosis.

Key Points

Highlights:

• Although early investigations identified that race is a risk factor for the development of endometriosis, further research is needed to explore the exact relationship.

Importance: 

• Patient-centered and personalized care should be provided in all women with suspicion of endometriosis without considering racial differences.

What’s done here?

• This viewpoint was written to reveal the misunderstanding that endometriosis is encountered in different races at different rates.
• The authors explained how the strong association between endometriosis and the white race was established and mentioned the most accepted pathophysiological mechanisms.
• The authors tried to summarize why there was a perception of racial difference in the diagnosis of endometriosis.
• The viewpoint was concluded by the current state of evidence about the distribution of endometriosis in different races.

Key results:

• Endometriosis was first described by John A. Sampson in 1921, then Sampson and his colleagues proposed several etiopathogenetic mechanisms explaining the development of endometriosis.
• Joseph Vincent Meigs claimed that endometriosis is a disease of white, middle-class women with delayed childbearing because of higher frequency among his private patients compared to the hospital.
• Later studies suggested the relationship between endometriosis and white race should be reviewed.
• Several confounding factors may cause this misinformation, such as:
  • Endometriosis could be presented differently in various ethnic groups and races
  • Studies investigating the underlying mechanisms were mostly performed in white women.
  • Socioeconomic status is an important factor influencing access to care, specialist referral, diagnosis, and treatment offered.
• The authors recommended the scientists to recognize that endometriosis could develop in various races with different symptoms and different treatment options may be required.

Lay Summary

Endometriosis is usually diagnosed in reproductive-aged women with an incidence of approximately 10%. The most common presenting symptoms are dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility in patients with endometriosis.

Some risk factors have been identified for the development of endometriosis. Unopposed estrogen exposure, early menarche, short menstrual cycles, long duration of menstrual flow, delayed childbearing, family history of endometriosis, and the white race are suggested to be associated with a higher risk of developing endometriosis.

The basis of the opinion that endometriosis develops more often in the white race was laid in the 1920s. Meigs proposed a theory that the long periods of uninterrupted menstruation leading to pathological changes in the coelomic epithelium. He also emphasized the higher incidence of endometriosis in white, middle-class women depending on his clinical experience.

Bougie et al., a group of scientists from Canada, published a viewpoint titled “Behind the times: revisiting endometriosis and race” in the journal "American Journal of Obstetrics & Gynecology". These authors sought to clarify the association between endometriosis and race.

They defined some confounding variables such as genetic and environmental factors influencing the development of endometriosis. The authors claimed that there might be selection bias regarding the racial differences of endometriosis. First, endometriosis could be presented differently in various ethnic groups and races. Studies investigating the underlying mechanisms of endometriosis were mostly performed in white women. Socioeconomic status as an important factor influencing access to care, specialist referral, diagnosis, and treatment offered affecting the interpretation.

“We advocate for adaptation of an individualized and patient-centered approach to the management of endometriosis to achieve a more accurate and timely diagnosis and improve patient management,”  they added.

Research Source: https://pubmed.ncbi.nlm.nih.gov/30738028/