“Silent” Endometriosis

Dr. Drew Tortoriello - March 10, 2022
“Silent” Endometriosis

 

Endometriosis is a pelvic inflammatory disease attributable to ectopic implants of uterine lining (endometrium) establishing a foothold in inappropriate locations in the pelvis, especially the ovaries, the peritoneal lining, and the bladder.  It is believed that retrograde menstrual flow through the fallopian tubes allows some still viable endometrial cells to enter the pelvis and implant where it lands.  In unusual circumstances, endometrial cells can travel and establish themselves in locations as distant as the lungs or the liver, likely through the blood.

Endometriosis affects 10–15% of all women of reproductive age and will be found in 70% of women with chronic pelvic pain.   About two-thirds of adolescent girls with chronic pelvic pain or dysmenorrhea have laparoscopic evidence of endometriosis, and about one-third have moderate-severe disease. The classic triad of endometriosis presentation is painful periods (dysmenorrhea), painful intercourse (dyspareunia) and infertility, although many patients with endometriosis at least initially do not have classic symptoms, something which poses a problem as it prevents a long-term mitigation strategy.

The percentage of hidden ore “silent” endometriosis is not insignificant as several studies have suggested. About 30%–50% of women undergoing “unrelated” surgery are diagnosed with incidental endometriosis—emphasizing frequent misdiagnosis of disease status.  Among asymptomatic fertile women undergoing tubal sterilization procedures, the incidence of endometriosis detected has ranged anywhere from 4% to 43%.   The incidence of f MRI-diagnosed endometriosis was 11% in a population cohort. 

Unfortunately, a silent presentation as well as the misdiagnosis of symptomatic endometriosis often leads to a delay in treatment, resulting in unnecessary suffering and reduced quality of life.  In patients aged 18–45 years, the average delay is 6.7 years.  As most women with endometriosis report the onset of symptoms during adolescence, early referral, diagnosis, identification of disease and treatment may mitigate pain, prevent disease progression, and thus preserve fertility. 

 

Pertinent literature

  1. Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, Jenkinson C, Kennedy SH, Zondervan KT.  World Endometriosis Research Foundation Global Study of Women’s Health consortium.  Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011 Aug;96(2):366–373.
  2. Greene R, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril. 2009;91:32–9. 
  3. Dun EC, Kho KA, Morozov VV, Kearney S, Zurawin JL, Nezhat CH. Endometriosis in adolescents. JSLS. 2015;19(2)

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