What are the most common symptoms of endometriosis and how are they related to age?

A study on a large cohort of endometriosis patients sheds light on the common symptomatology of the disease

Key Points

Highlight

• Increasing the knowledge and awareness of the symptomatology of endometriosis might help in overcoming the delay in the diagnosis and treatment.

Importance

• Achieving to diagnose endometriosis earlier when it is still not advanced will help the patients have better control of their symptoms and treat the disease before it is advanced. 
• It is crucial for physicians to deeply understand the symptomatology of endometriosis to be able to give a correct and punctual diagnosis.

What's done here

• This is a retrospective study performed on a large cohort of endometriosis patients with the aim to evaluate the most common symptoms of endometriosis, their course throughout the reproductive period, and the relation between the age of onset.
• A total of 4083 patients were diagnosed with endometriosis and followed up accordingly were included in the study.

Key results

• The most common symptoms were abdominal pain, dyspareunia, chronic fatigue syndrome, and bowel disorders.
• The least common symptoms were bladder pain and cystitis.
• There was an increased incidence of symptoms between the age groups 25-29 years and 40-44 years.
• A higher incidence of symptoms was seen in employers, graduates, and freelancers compared to the people who did not work.
• The number of children was shown to have a protective effect on chronic fatigue syndrome.
• Usage of oral contraceptive pills had a protective effect on ovulatory pain.

Lay Summary

Even though the incidence of endometriosis is relatively high and numerous studies are being conducted to elucidate its pathogenesis, it is still a highly underdiagnosed and undertreated disease.

The symptoms of the disease are well-known; however, the correlation between the age of onset and the course of the symptoms throughout the reproductive life of the patients has not been evaluated in large cohorts before. Signorile et al. from Italy have conducted an extensive retrospective study that aimed to determine the frequency of all the different symptoms in endometriosis and analyze their course and correlation with the age of onset. They included a cohort of 4083 patients diagnosed and followed up during a 10-year period. The study was published in the March-April 2022 issue of the journal In Vivo.

The most common symptoms were reported as “the swollen abdomen,” which refers to abdominal pain and dyspareunia with an incidence of 65%, chronic fatigue syndrome seen in 62%, and bowel disorders that seemed to have affected more than half of the patients. These findings were found to be in concordance with the literature. The least reported symptom was bladder pain along with cystitis, and chronic pelvic pain was only reported by one-quarter of the patients in this study, which is in contrast to other studies in the literature. The authors discuss that these findings will contribute to the common symptomatology of the disease.

When the distribution of the symptoms was analyzed regarding the age of the patients, an increased incidence was witnessed starting from the age group 25-29 years up to 40-44 years, with a significant decrease in the age group 55-59 years, which was linked to the ovarian estrogenic hormonal activity by the authors. They also stated that this trend might be the reason for the delay in the initial diagnosis.

Employers, graduates, and freelancers had a higher incidence compared to the other professions. The lowest incidence was seen in people who did not work; housewives, pensioners, students, and the unemployed. The type of occupation was found to influence the symptoms.

A significant protective effect of the number of children was discovered on chronic fatigue syndrome. It was thought that the changes that come with the pregnancy have some effects on the body. On the other hand, the patients who gave birth were found to have a higher incidence of chronic pelvic pain. Lastly, a protective effect was discovered between the usage of oral contraceptive pills and ovulatory pain, and this was linked to the estrogen metabolism.

The authors conclude by saying that the results of this study will hopefully help reduce the delay in the diagnosis.

Research Source: https://pubmed.ncbi.nlm.nih.gov/35241545/