Background:
The diagnosis of endometriosis remains challenging given its variable clinical presentation, unclear biology and necessity for surgical or histopathological diagnosis through laparoscopy. The prevalence of endometriosis is estimated to be 6–10% among women in their reproductive years (1) and this can increase up to 70-90% in patients who present with chronic pelvic pain (2). However, there is scarce data on the incidence of endometriosis in women above the age of 40 who present with pelvic pain.
Objective:
To investigate the incidence of endometriosis in women above the age of 40 who present with pelvic pain and who were not previously diagnosed with endometriosis.
Method:
A retrospective study of women who presented to a pelvic pain focused gynaecology clinic at the Royal Women’s Hospital, Parkville, Victoria between 2013 and 2016. Included were premenopausal women above the age of 18 who presented with pelvic pain and were booked for a laparoscopy for investigation of this pain. Patients who had a previous laparoscopy and those who had sonographic evidence of endometriosis were excluded. Patients who met the inclusion criteria were divided into groups according to age (<40 and > 40 years). Patients were included in a 1:1 ratio (above and below the age of 40). Demographic, clinical, surgical and histopathology data was collected from medical records. Rates of a new diagnosis of endometriosis, based on surgical findings and histopathology, were compared between the two groups.
Results:
During the study time frame, 722 women have presented to the clinic with pelvic pain and were booked for laparoscopy. Of these, 120 (16.6%) met the inclusion criteria and were included in the study. Endometriosis was diagnosed in 33.3% of patients aged 40 and above and in 78.3% of patients below the age of 40 (p<0.001). Deep infiltrating endometriosis was diagnosed in none of the women at or above age 40 and 10% of women below the age of 40 (p=0.01).
Conclusion:
The likelihood of a new diagnosis of endometriosis above the age of 40 is lower than in younger women. Therefore careful counselling and consideration of the risks of surgery is recommended prior to performing a laparoscopy for investigation of pelvic pain in this age group.