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Endometriosis: epidemiology and aetiological factors

https://doi.org/10.1016/j.bpobgyn.2004.01.007Get rights and content

Abstract

Estimates of the frequency of endometriosis vary widely. Based on the few reliable data, the prevalence of the condition can reasonably be assumed to be around 10%. Although no consistent information is available on the incidence of the disease, temporal trends suggest an increase among women of reproductive age. This could be explained—at least in part—by changing reproductive habits. Numerous epidemiological studies have indicated that nulliparous women and women reporting short and heavy menstrual cycles are at increased risk of developing endometriosis; data on other risk factors are less consistent. These epidemiological findings strongly support the menstrual reflux hypothesis. Additional evidence in favour of this theory includes the demonstration of viable endometrial cells in the menstrual effluent and peritoneal fluid, experimental implantation and growth of endometrium within the peritoneal cavity, observation of some degree of retrograde menstruation in most women undergoing laparoscopy during menses, and an association between obstructed menstrual outflow and endometriosis.

Section snippets

Frequency

Few well-conducted studies have reported data on the prevalence of endometriosis and no data are available on the frequency of the onset of the disease in a given period (its incidence) in women without a previous diagnosis.

Differences in the prevalence of the disease vary by as much as 30–40 times.8., 9., 10., 11., 12., 13., 14., 15. Studies that have analysed the frequency of endometriosis in women who underwent surgery for fibroids have suggested a prevalence of the condition of about 10%10,

Peritoneal endometriosis

The mechanism of histogenesis referred to as implantation theory, or Sampson's theory, suggests that endometriotic lesions result from the reflux of viable endometrial tissue through the fallopian tubes that implants on peritoneal surface or pelvic organs.4 Substantial evidence exist to support this hypothesis: (1) viable endometrial cells have been demonstrated in the menstrual effluent and peritoneal fluid51; (2) endometrium can be implanted experimentally and grown within the peritoneal

Summary

Estimates of the frequency of endometriosis vary widely. Based on the few reliable data, the prevalence of the condition is around 10%. Although there is no consistent information on the incidence of the disease, temporal trends suggest an increase among women of reproductive age. This can be partly explained by changing reproductive habits. Numerous epidemiological studies have indicated that nulliparous women and women reporting short and heavy menstrual cycles are at increased risk of

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