{"paper_id":"5d42f69e-5e34-4bcd-8a7a-a17d3ed24240","body_text":"694\n© Aluna Publishing\nWiadomości Lekarskie Medical Advances, VOLUME LXXVIII, ISSUE 4, APRIL 2025    \nINTRODUCTION\nEndometriosis is a common benign gynecological dis-\nease in female of reproductive age, but the prevalence \nof these condition is not exactly known. According \nto the literature, prevalence of endometriosis affects \nup to 10% of females worldwide [1] and it most often \noccurs on or around reproductive organs in the pelvis, \nincluding Fallopian tubes, Ligaments around the uterus, \nLining of the pelvic cavity, Ovaries, Outside surface of \nthe uterus, Cervix, Vagina or vulva, Space between the \nuterus and the rectum or bladder. \nEndometriosis significantly impacts women’s repro-\nductive health. This disease not only leads to reduced \nfemale fertility but may also be a risk factor for adverse \npregnancy outcomes [2-5]. Moreover, endometriosis \nassociated with depression, fatigue, and a reduction \nin work productivity, leading to a substantial economic \nburden [6]. According to the literature, endometriosis \nEpidemiology of endometriosis in female evacuated from \nthe Eastern Ukrainian military conflict regions: results a \nmulticenter study (2022-2024)\nAidyn G. Salmanov1, Igor V. Maidannyk2, Olena O. Chorna2, Oleksandr V. Zabudskyi3, \nVolodymyr V. Artyomenko4, Pankiv V. Mariana5, Lidiya V. Suslikova6, Vitalii S. Strakhovetskyi7,8, \nVictor O. Rud9, Svitlana M. Korniyenko4, Serhii Yu. Vdovychenko6, Andriy I. Chubatyy2,  \nSerhii V. Dudka6, Karina Voronina6\n1UKRAINIAN CENTER OF MATERNITY AND CHILDHOOD OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV , UKRAINE \n2BOGOMOLETS NATIONAL MEDICAL UNIVERSITY , KYIV , UKRAINE\n3MATERNITY HOSPITAL  No 2,, KYIV , UKRAINE\n4ODESA NATIONAL MEDICAL UNIVERSITY , ODESA, UKRAINE\n5PRIVATE HIGHER EDUCATIONAL INSTITUTION “LVIV MEDICAL UNIVERSITY” , LVIV , UKRAINE\n6SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV , UKRAINE\n7KHARKIV NATIONAL MEDICAL UNIVERSITY , KHARKIV , UKRAINE\n8MEDICAL CENTRE “ASHERA” , KHARKIV , UKRAINE\n9NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY , VINNYTSIA, UKRAINE\nABSTRACT\nAim: To estimate the prevalence and risk factors associated with endometriosis in female evacuated from the Eastern Ukrainian military conflict regions.\nMaterials and Methods: A prospective multicenter cohort study was based on surveillance data for endometriosis. 982 women undergoing pelvic surgery \nwere compared to 264 patients unexposed to surgery. The study cohort included women, who underwent a diagnostic and/or therapeutic laparoscopy or \nlaparotomy in 2022-2024. Endometriosis among women was diagnosed visually at laparoscopy/laparotomy or by pelvic magnetic resonance imaging.\nResults: The prospective multicenter study included 1,246 women. The overall prevalence of endometriosis was 31.5%. Prevalence of the three types of endo-\nmetrioses included peritoneal/superficial endometriosis, ovarian endometriotic cyst/endometrioma and deep infiltrating endometriosis was 13.8%, 9.8%, and \n4.8%, respectively. Three hundred sixty-one women 36,8% in the surgical group and thirty-one women 13.3% in the community treatment group (unexposed \nto surgery, population cohort) were diagnosed with incident endometriosis. The pelvic pain, infertility and early age at menarche to be a consistent risk factor for \nendometriosis in both the operative and population cohorts. Data analysis showed that odds were decreased for gravidity, parity, and BMI. Factors that increased \nthe odds of endometriosis diagnosis included dysmenorrhea, older age at first sex, pelvic pain as a surgical indication for laparoscopy, and higher education.\nConclusions: Our study findings demonstrate the high prevalence of endometriosis among women in Ukraine. The pelvic pain, infertility and early age at \nmenarche to be a consistent risk factor for endometriosis in both the operative and population cohorts. \n KEY WORDS : women evacuated from the military conflict regions, endometriosis, prevalence, risk factors, Ukraine\nWiad Lek. 2025;78(4):694-701. doi: 10.36740/WLek/203835 DOI\nORIGINAL ARTICLE CONTENTS\n\nEpidemiology of endometriosis in female evacuated from the Eastern Ukrainian military conflict regions...\n695\nimposes a yearly cost of ~$78 billion in the United \nStates [7]. The health care costs for endometriosis were \napproximately $4,000 per affected woman [8]. In Bel-\ngium annual total cost per woman with endometriosis \nwas €9579 [7].\nEndometriosis predominantly affects women in \ntheir reproductive years and characterized by lesions \nresembling the endometrium found outside the uterus \n(ectopic endometrium), primarily in the pelvic tissues \nand organs [9, 10]. In addition, ectopic endometrium \ncan invade almost any part of the body, including the \nlungs and pleura, but most commonly the pelvic organs \nand parietal peritoneum [11]. The most common signs \nof endometriosis in female are painful periods, painful \nintercourse, chronic pelvic pain, ovarian cysts, and in-\nfertility [12]. However, these symptoms aren’t exclusive \nto endometriosis, there may be other conditions. The \nvaried symptomatology can also be attributed to other \nconditions [13]. The complex diagnostic challenge of \nendometriosis drives the delay in diagnosis. In addition, \nthere are no effective biomarkers for the detection of \nendometriosis.\nThe pathogenesis of endometriosis is multifactorial \nand include retrograde menstruation, celomic metapla-\nsia, embryologic rests, and lymphovascular spread [14]. \nEtiology and the association between the severity and \nlocation of endometriosis remains unclear [15]. Current \nsurgical and medical approaches (including hormonal \ntreatments) to endometriosis are ineffective for a siz-\nable proportion of women. According to the literature, \napproximately 50% of women with endometriosis have \nrecurrent symptoms over a period of 5 years, irrespective \nof the treatment approach [16]. An improved under -\nstanding of the pathogenesis of endometriosis is needed \nfor the development of targeted medical approaches. \nHowever, no studies have been conducted on endome-\ntriosis in women living in the zone of the Ukrainian-Rus-\nsian military conflict. Knowledge of endometriosis and \nrisk factors in these regions are unknown. \nAIM\nThe aim this study to estimate the prevalence and \nrisk factors associated with endometriosis in female \nevacuated from the Eastern Ukrainian military conflict \nregions.\nMATERIALS AND METHODS\nSTUDY DESIGN AND POPULATIONS\nA prospective multicenter cohort study was based on \nsurveillance data for endometriosis. The study cohort \ncomprised 1,246 women, aged 18–49 years, who were \nevacuated from the Eastern Ukrainian military conflict \nregions. Participants in this study were admitted to \ngynecologic departments at hospitals located in the \nKyiv (4 hospitals), Vinnytsia (2 hospitals), Lviv (2 hospi-\ntals), Kharkiv (2 hospitals) and Odesa (2 hospitals) sites. \nIn this study, 982 women undergoing pelvic surgery \n(exposed to surgery, operative cohort) were compared \nto population cohort of 264 women (unexposed to sur-\ngery, population cohort). The cohort included currently \nmenstruating women, who underwent a diagnostic \nand/or therapeutic laparoscopy or laparotomy at 1 \nof 4 participating hospitals in June 1st, 2022 through \nDecember 31st, 2024. In this study, any surgical indi-\ncation was acceptable and included pelvic pain, pelvic \nmass, menstrual irregularities, fibroids, tubal ligation, \nand infertility. Endometriosis among women was diag-\nnosed visually at laparoscopy/laparotomy or by pelvic \nmagnetic resonance imaging (MRI) in the operative and \npopulation cohorts, respectively.\nExclusion criteria: previous laparoscopic diagnosis \nof endometriosis; currently breast-feeding; history of \ncancer other than nonmelanoma skin cancer; currently \nhormonal therapy; women with urinary tract infection \nand gastrointestinal infections; women who refused to \nsign the informed consent form.\nDEFINITION\nIn the present study, endometriosis is defined as a \ndisease characterized by the presence of endometri-\num-like epithelium and/or stroma outside the endo -\nmetrium and myometrium, usually with an associated \ninflammatory process [16]\nDATA COLLECTION\nIn this study, we analyzed the inpatient data medical \nrecords to identify and describe the epidemiology of \nendometriosis. Medical records and epidemiological \ndata were used to find risk factors for endometriosis. \nA standard data collection form was created to extract \ndemographic and clinical data. The standardized data \ncollection protocol included interview administered \nat baseline, an anthropometric assessment including \nbody mass index (BMI). All participants were queried \nregarding sociodemographic characteristics, medical \nand reproductive history, pain, and life-style. The \nprotocol was administered for the operative cohort \nand population cohort (patients unexposed to sur -\ngery). In addition, for operative cohort completed a \nstandardized report immediately following surgery \nto capture gynecologic pathology and endometriosis \n\nAidyn G. Salmanov et al. \n696\nTable 1. Characteristics by female evacuated from the Eastern Ukrainian military conflict regions and endometriosis diagnosis, 2022-2024 (n=1,246)\nEndometriosis\nOperative cohort (n = 982) Population cohort (n = 264)\nEndometriosis\n(n = 361) \nNo endometriosis\n(n = 621)\nEndometriosis\n(n = 31)\nNo endometriosis\n(n = 233)\nn % n % n % n %\nAge, y\n <20 9 2.6 15 2.4 0 0 9 3.9\n 20–24 42 11.6 57 9.2 8 25.8 43 18.5\n 25–29 91 25.2 121 19.5 2 6.5 46 19.7\n 30–34 84 23.3 129 20.8 6 19.4 36 15.5\n ≥35 135 37.4 299 48.1 15 48.4 99 42.5\nMarital status \n Married 304 84.2 481 77.5 28 90.3 185 79.4\n Other 57 15.8 140 22.5 3 9.7 48 20.6\nEducation \n Less than College grad 114 31.6 201 32.4 17 54.8 104 44.6\n College grad or higher 247 68.4 420 67.6 14 45.2 129 55.4\nAlcohol consumer \n Never 84 23.3 138 22.2 7 22.6 66 28.3\n Past 116 32.1 207 33.3 13 41.9 82 35.2\n Present 161 44.6 276 44.4 11 35.5 85 36.5\nAge at first consenting sex\n ≤17 174 48.2 345 55.6 8 25.8 114 48.9\n 18–20 95 26.3 147 23.7 14 45.2 78 33.5\n ≥21 92 25.5 129 20.8 9 29.0 41 17.6\nEver use oral contraceptives\n No 40 11.1 98 15.8 3 9.7 36 15.5\n Yes 321 88.9 523 84.2 28 90.3 197 84.5\nGravidity                \n Nulligravid (0) 154 42.7 163 26.2 11 35.5 95 40.8\n Gravid (≥1) 207 57.3 458 73.8 20 64.4 138 59.2\nParity (no. of live births)\n Nulliparous 71 19.7 76 12.2 4 12.9 36 15.5\n Parous 290 80.3 545 87.8 27 87.1 197 84.5\nAge at first pregnancy, y\n <20 143 39.6 221 35.6 1 3.2 48 20.6\n 20–24 134 37.1 202 32.5 12 38.7 94 40.3\n 25–29 66 18.3 109 17.6 9 29.0 68 29.2\n 30–34 13 3.6 71 11.4 5 16.1 15 6.4\n 35–39 5 1.4 14 2.3 1 3.2 4 1.7\n ≥40 0 0 4 0.6 3 9.7 4 1.7\nHistory STIs\n No 304 84.2 481 77.5 28 90.3 185 79.4\n Yes 57 15.8 140 22.5 3 9.7 48 20.6\nHistory of abnormal pap smear                \n No 281 77.8 461 74.2 26 83.9 165 70.8\n Yes 80 22.2 160 25.8 5 16.1 68 29.2\n\nEpidemiology of endometriosis in female evacuated from the Eastern Ukrainian military conflict regions...\n697\ndiagnosis and staging using the revised criteria from \nthe American Society for Reproductive Medicine \n(rASRM) [17]. rASRM staging was categorized as: stage \nI, minimal (scores 1–5); stage II, mild (scores 6–15); \nstage III, moderate (scores 16–40); or stage IV, severe \n(scores >40) [17]. All women in the population cohort \n(patients without prior surgery) underwent a pelvic \nMRI to assess any gynecologic pathology including \nendometriosis. Using protocol for pelvic imaging, 1 \nradiologist supervised and evaluated all MRI. These \nresults were confirmed by a second radiologist with \nexpertise in gynecologic imaging. In present study \nendometriosis among women diagnoses were derived \nfrom visualization by the surgeon in the operative \ncohort and from MRI in the population cohort (pa-\ntients unexposed to surgery). Histologically confirmed \nendometriosis required the presence of endometrial \nglands and/or stroma.\nETHICS\nThe study was approved by the Institutional Ethics \nCommittee of the Ukrainian center of maternity and \nchildhood of the National Academy of Medical sciences \nof Ukraine. All participants provided informed consent \nbefore any data collection. \nSTATISTICAL ANALYSIS\nIn this study was performed by using SPSS program \n(Version 18, Chicago, IL, USA). Descriptive statistics \nwere reported in numbers and percentages. In this \nstudy the associations between categorical variables \nwere assessed by χ2 statistic or the Student t test. \nOdds ratio (OR) and 95% confidence interval were \nalso calculated for all factor. Factors associated with \nendometriosis were investigated using logistic re -\ngression analysis model. We used stepwise logistic \nregression in a backward manner. In ordinal regression \nanalysis, predictors which probably reflect symptoms \nof endometriosis (such as dyspareunia, dysmenorrhea \nand pelvic pain) were examined. Logistic regression \nestimated the adjusted odds ratios (AORs) and 95% \nconfidence intervals for each cohort. We in each cate-\ngory compared the mean predicted probability in that \nparticular category with the observed probability. In \nthis study P values less than 0.05 (< 0.05) were consid-\nered to be statistically significant.\nRESUL TS\nPREVALENCE OF ENDOMETRIOSIS\nA total the study cohort comprised 1,246 women, who \nwere evacuated from the Eastern Ukrainian military \nconflict regions. The overall prevalence of endometri-\nosis among these women was 31.5% [95% confidence \ninterval (CI), 30.2-32.8]. The number of surgically visu-\nalized endometriosis among women in the operative \ncohort was 361/982 and 31/233 in the population \ncohort based on MRI. MRI-visualized endometriosis in \nthe population cohort consisted of primarily ovarian \nEver seek infertility treatment\n No 239 66.2 514 82.8 23 74.2 211 90.6\n Yes 122 33.8 107 17.2 8 25.8 22 9.4\nSurgical indication\n Pelvic pain 228 63.2 188 30.3\n Pelvic mass 49 13.6 107 17.2\n Menstrual irregularity 38 10.5 97 15.6\n Fibroids 17 4.7 95 15.3\n Tubal ligation 15 4.2 89 14.3\n Infertility 14 3.9 45 7.2\nMenarche, y\n ≤11 168 46.5 325 52.3 15 48.4 64 27.5\n 12–13 121 33.5 189 30.4 11 35.5 131 56.2\n ≥14 72 19.9 107 17.2 5 16.1 38 6.3\nBMI (mean±SD) 27.6 ± 7.7 29.4 ± 8.2 27.2 ± 5.5 27.8 ± 6.4\nSD, standard deviation; STIs, sexually transmitted disease; BMI, Body Mass Index.\nTable 1. Cont.\n\nAidyn G. Salmanov et al. \n698\ntion-based cohort (AOR, 7.14; 95% CI, 1.73–29.8), even \nafter adjusting for age. A pelvic pain history increased \nthe odds of an endometriosis diagnosis in the opera-\ntive cohort (adjusted odds ratio [AOR], 3.66; 95% CI, \n2.45–5.51), and in the population cohort (AOR, 5.51; \n95% CI, 2.61–7.72). Also, in our study, early menarche \nhistory increased the odds of an endometriosis diagno-\nsis in the operative cohort (adjusted odds ratio [AOR], \n2.47; 95% CI, 1.47–5.31), and in the population cohort \n(AOR, 3.97; 95% CI, 2.64–5.73), even after adjusting for \nage and study site. Data analysis showed that odds \nwere decreased for gravidity, parity, and BMI. Factors \nthat increased the odds of endometriosis diagnosis \nincluded dysmenorrhea, older age at first sex, pelvic \npain as a surgical indication for laparoscopy, and higher \neducation. In this study, we found no association with \nendometriosis for any aspect of menstrual history \n(Table 2).\n \nDISCUSSION\nThis study was performed to estimate the prevalence \nand risk factors associated with endometriosis in female \nevacuated from the Eastern Ukrainian military conflict \nregions, who admitted to gynecologic departments at \nregional hospitals located in the Kyiv, Vinnitsa, L ’viv and \nOdesa sites. In this study, women undergoing pelvic \nsurgery were compared to population cohort (unex -\nposed to surgery). The incidence of surgically visualized \nendometriomas, and included nodular implants (stage \n3–4 by rASRM). The prevalence of endometriosis by \nrASRM stage ranged from 4.6% for stage 4 to 23.8% \nfor stage 1. Of all endometriosis cases, 36.8% were \nperitoneal/superficial endometriosis, 48.4% were \novarian endometriotic cyst/endometrioma and 14.8% \nwere deep infiltrating endometriosis. Prevalence of \nthe three types of endometrioses included peritoneal/\nsuperficial endometriosis, ovarian endometriotic cyst/\nendometrioma and deep infiltrating endometriosis \nwas 13.8%, 9.8%, and 4.8%, respectively. Three hun-\ndred sixty-one women 36,8% [95% (CI), 35,4-38,0) in \nthe surgical group and thirty-one women 13.3% [95% \n(CI), 12.3-14.3) in the community treatment group \n(unexposed to surgery, population cohort) were \ndiagnosed with incident endometriosis. Detailed of \nsocio-demographic, gynecological and clinical char -\nacteristics of study participants who were evacuated \nfrom the Eastern Ukrainian military conflict regions \nare presented in Table 1.\nRISK FACTORS FOR ENDOMETRIOSIS\nIn this study, logistic regression identified only three \nconsistent risk factors across both cohorts—history \nof infertility, early age at menarche and pelvic pain. \nA history of infertility increased the odds of endome -\ntriosis diagnosis in the surgical cohort (adjusted odds \nratio [AOR], 2.44; 95% CI, 1.56–3.78) and in the popula-\nTable 2. Risk factors for endometriosis by female evacuated from the Eastern Ukrainian military conflict regions, 2022-2024 (n = 1,246)\nRisk factor\nOperative cohort\n(n = 982)\nPopulation cohort\n (n = 264)\nUnadjusted OR\n (95% CI)\nAdjusted OR\n (95% CI)\nUnadjusted OR\n (95% CI)\nAdjusted OR\n (95% CI)\nSociodemographic\n Age, y 0.97 (0.94–0.99 1.02 (0.95–1.09)\n Poverty level 1.54 (0.83–2.81) 1.89 (1.00–3.53) 0.87 (0.18–4.25) 0.87 (0.18–4.54)\n    Educated level 1.63 (1.00–2.64) 1.83 (1.12–3.00) 0.58 (0.11–2.98) 0.58 (0.11–3.13)\nReproductive history        \n Gravid vs nulligravid 0.48 (0.34–0.72) 0.49 (0.33–0.76) 1.25 (0.41–3.95) 1.03 (0.28–3.79)\n Parous vs nulliparous 0.47 (0.33–0.69) 0.42 (0.27–0.65) 1.31 (0.43–4.03) 1.06 (0.27–3.97)\n Infertility history 2.51 (1.62–3.86) 2.44 (1.56–3.78) 7.14 (1.73–29.8) 7.92 (1.67–37.4)\n Age at first consenting sex 1.06 (1.01–1.13) 1.06 (1.02–1.14) 1.08 (0.87–1.31) 1.06 (0.88–1.29)\n Surgical indication for laparoscopy 3.91 (2.64–5.77) 3.66 (2.45–5.51)    \nMenstruation        \n Early age at menarche, y 2.79 (1.47–5.31) 2.47 (1.29–4.74) 3.97 (2.64–5.73) 3.68 (2.45–5.57)\n Dysmenorrhea (yes/no) 1.07 (0.95–1.19) 1.05 (0.93–1.18) 1.38 (0.28–6.59) 1.42 (0.28–7.16)\nPelvic pain 3.91 (2.64–5.77) 3.66 (2.45–5.51) 5.48 (2.66–9.88) 5.41 (2.61–7.72)\nBody mass index, kg/m2 0.95 (0.94–0.98) 0.95 (0.94–0.98) 1.01 (0.93–1.09) 1.01 (0.93–1.09)\n\nEpidemiology of endometriosis in female evacuated from the Eastern Ukrainian military conflict regions...\n699\namong women hospitalized with pelvic pain [19]. In our \nstudy, prevalence of asymptomatic women with endo-\nmetriosis was 13.3%. A previous study, the prevalence of \nendometriosis among Ukrainian women was 28.4% [22]. \nIn present study the overall prevalence of endometriosis \namong women in present study was 31.5%. \nCurrently, the etiology of endometriosis remains \nunknown. Prior studies identified a variety of endo -\nmetriosis risk factors including abnormal or heavy \nbleeding, dysmenorrhea, dyspareunia, dysuria, and \npelvic pain, age, alcohol use, early menarche, family \nhistory of endometriosis, infertility, intercourse during \nmenses, low body weight, prolonged menstrual flow \n[14, 19, 22-26]. In present study, infertility, pelvic pain, \nand early age at menarche to be a consistent risk factor \nfor endometriosis in both the operative and population \ncohorts. Other risk factors either decreased or increased \nthe odds of an endometriosis diagnosis.\nSTRENGTH AND LIMITATIONS\nStrength: The main strength of this study is the utiliza-\ntion of surveillance data for prevalence and causal in-\nference of endometriosis. This work may be considered \nthe first of epidemiological studies in Ukraine in order to \nestimate the prevalence and risk factors associated with \nendometriosis in female evacuated from the Eastern \nUkrainian military conflict regions. Our results provide \nnew data for a comprehensive assessment of the prev-\nalence and risk factors of endometriosis in Ukraine.\nLimitations: (1) The prevalence and risk factor data \nare derived exclusively in female evacuated from the \nEastern Ukrainian military conflict regions. Therefore, \nthe findings may not be extrapolated to other female \ngroups and regions. More comprehensive studies across \ndifferent regional groups of female are needed; (2) Al-\nthough the available large female evacuated from the \nmilitary conflict regions data, follow-up research efforts \nshould focus on further expanding the sample size to \nproduce more precise assessments on endometriosis.\nCONCLUSIONS\nOur study findings demonstrate the high prevalence \nof endometriosis among women in Ukraine. The pel-\nvic pain, infertility and early age at menarche to be \na consistent risk factor for endometriosis in both the \noperative and population cohorts. However, whether \nthese factors are causal or merely represent a feature of \nthe pathophysiological process remains uncertain. The \nlack of an effective diagnosis of endometriosis in female \nleads to delayed or missed diagnosis are associated \nwith reduced quality of life and high financial costs to \nendometriosis in the operative cohort was 36.8% and \n13.3% in the population cohort. The prevalence of en-\ndometriosis by rASRM stage ranged from 4.6% for stage \n4 to 23.8% for stage 1. Of all endometriosis cases, 36.8% \nwere peritoneal/superficial endometriosis, 48.4% were \novarian endometriotic cyst/endometrioma and 14.8% \nwere deep infiltrating endometriosis. Prevalence of \nthe three types of endometrioses included peritoneal/\nsuperficial endometriosis, ovarian endometriotic cyst/\nendometrioma and deep infiltrating endometriosis \nwas 13.8%, 9.8%, and 4.8%, respectively. In this study \nwe found infertility, pelvic pain, and early age at men-\narche to be a consistent risk factor for endometriosis \nin both the operative and population cohorts. Other \nrisk factors either decreased or increased the odds of \nan endometriosis diagnosis.\nEndometriosis is a common, chronic, gynecological \ncondition that affects approximately 5–10 % of women \nof reproductive age worldwide [18]. According to the \nliterature, endometriosis is estimated to affect approx-\nimately from 176 million [8] to 190 million of reproduc-\ntive-age women worldwide [19]. The true prevalence \nof these disease in women is unknown. Literature data \non the prevalence of endometriosis vary widely among \npopulation samples and diagnostic approaches, and \non characteristics of the study population. In addition, \ndifferences in prevalence and diagnosis of female en-\ndometriosis patients are caused by differential access \nto healthcare, views, society, economy, education, \nmedical conditions, and security systems and other \nfactors. Moradi Y, et al. reported that the prevalence of \nendometriosis by the continent ranged from 17% for \nEurope to 36% for Asia [1].\nDespite the high prevalence of endometriosis, di-\nagnosing the condition remains challenging. In USA \nduring the 10-year study period (2006-2016), among \n332,0562863 women incident endometriosis cases \nwere identified for an average incidence 24.3%. The \ndistribution of the 2863 incident cases by the diagnosis \nmodality was as follows: 45.5% surgical, 5.7% imaging, \nand 48.8% clinical [20]. The results of our study showed \nthat the prevalence of endometriosis diagnosed with \nlaparoscopy, ultrasound and magnetic resonance \nimaging (MRI) methods was higher than endometri-\nosis diagnosed with other diagnostic methods. Other \nstudies have shown the same results regarding the \nprevalence of endometriosis. Another study showed \nthe same results prevalence of endometriosis [1, 21]. \nAccording to the literature, many women with this \npathology are asymptomatic, while others may report \nnon-specific symptoms. Shafrir AL, et al. reported that the \nprevalence ranged from 2 to 11% among asymptomatic \nwomen, 5 to 50% among infertile women, and 5 to 21% \n\nAidyn G. Salmanov et al. \n700\nurgently needed, as are new therapeutics that target \nthe varied physiological pathways related to the devel-\nopment and progression of endometriosis. These can \nbe achieved through collaborative, multidisciplinary \nresearch and the prioritization of endometriosis as an \nimportant public health issue.\nthe patient and the healthcare system. An improved \nunderstanding of the pathogenesis of endometriosis \nis needed for the development of targeted medical ap-\nproaches. Given the high prevalence of endometriosis, \nthe negative effect of the disease on female health and \nthe high associated economic costs, biomarkers are \nREFERENCES\n 1.  Moradi Y , Shams-Beyranvand M, Khateri S et al. A systematic review on the prevalence of endometriosis in women. Indian J Med Res. \n2021;154(3):446-454. doi: 10.4103/ijmr.IJMR_817_18. DOI\n 2.  Chen I, Lalani S, Xie RH et al. Association between surgically diagnosed endometriosis and adverse pregnancy outcomes. 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Risk factors associated with endometriosis: importance of study population for \ncharacterizing disease in the ENDO Study. Am J Obstet Gynecol. 2013;208(6):451.e1-11. doi: 10.1016/j.ajog.2013.02.040. DOI\n 26.  Halis G, Mechsner S, Ebert AD. The diagnosis and treatment of deep infiltrating endometriosis. Dtsch Arztebl Int. 2010;107(25):446-\n55;quiz 456. doi: 10.3238/arztebl.2010.0446. DOI\nThe authors wish to acknowledge all the study subjects who provided us with the information required for conducting \nthis study.\nCONFLICT OF INTEREST\nThe Authors declare no conflict of interest\nCORRESPONDING AUTHOR\nAidyn G. Salmanov \nShupyk National Healthcare University of Ukraine, \n9 Dorohozhytska St., 04112 Kyiv, Ukraine \ne-mail: mozsago@gmail.com\nORCID AND CONTRIBUTIONSHIP\nAidyn G. Salmanov: 0000-0002-4673-1154  \nIgor V. Maidannyk: 0000-0003-0849-0406  \nOlena O. Chorna: 0000-0002-9137-5056  \nOleksandr V. Zabudskyi: 0000-0003-1969-7031  \nVolodymyr V. Artyomenko: 0000-0003-2490-375X  \nPankiv V. Mariana: 0000-0002-3714-2577  \nLidiya V. Suslikova: 0000-0002-3039-6494  \nVitalii S. Strakhovetskyi: 0000-0002-7528-1498  \nVictor O. Rud: 0000-0002-0768-6477  \nSvitlana M. Korniyenko: 0000-0003-3743-426X  \nSerhii Yu. Vdovychenko: 0000-0002-9205-510X  \nAndriy I. Chubatyy: 0000-0003-0375-5556  \nSerhii V. Dudka: 0009-0009-5168-7694  \nKarina Voronina:  0000-0002-8554-6314  \n – Work concept and design,  – Data collection and analysis,  – Responsibility for statistical analysis,  – Writing the article,  – Critical review,  – Final approval of the article\nRECEIVED: 11.01.2025\nACCEPTED: 30.03.2025\n CREATIVE COMMONS 4.0","source_license":"CC0","license_restricted":false}