{"paper_id":"86d65bbe-9da4-4342-91dd-8b556d5593c3","body_text":"Original Article | JOGCR. 2024; 9(3):335-339 \n     Volume 9, May – June 2024       Journal of Obstetrics, Gynecology and Cancer Research \n Journal of Obstetrics, Gynecology and Cancer Research | ISSN: 2476-5848 \n \nEndometriosis: A Six-Year Epidemiological Study \n \nBehnaz Nouri1* , Sare Naz Aghili1, Malihe Arab2  \n \n1. The Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran \n2. Department of Gynecology  Oncology, Imam Hossein Medical Center, Shahid Beheshti University of Medical \nSciences, Tehran, Iran \n \nArticle Info  ABSTRACT \n  \n          10.30699/jogcr.9.3.335 \n \n \n \nBackground & Objective:  The etiology of endometriosis is unknown and many \nhormonal, inflammatory, genetic and environmental factors are effective in the \nformation of endometriosis. The present study investigated the epidemiology of \nendometriosis in patients referred to ShohadayeTajrish Hospital in six years. \nMaterials & Methods: This descriptive study performed on endometriosis Iranian \nw\nomen who referred to ShohadayeTajrish Hospital between 2016 and 2022. The \nsample size of this study was determined using the census method, and 711 patients. \nFor analysis, SPSS version 22 was used, and results were reported as mean ± SD. \nResults: Finally, 711 patients enrolled in this study and the average age of patients was \n34.69±\n 7.53 years and the mean age of onset of disease was 29.97±4.61years. More \nthan 55% of patients had a healthy weight and normal body mass index. 17.72 percent \nof patients had a history of infertility in their life’s. \nConclusion: Endometriosis patients’ life in many aspects, including their job, \nli\nfestyle, education, marital status and health care is affected. \nKeywords: Endometriosis, Epidemiology, Prevalence, Pregnancy  \nReceived:  2023/10/16; \nAccepted: 2024/01/07; \nPublished Online: 15 May 2024; \n \n \nUse your device to scan and read the \narticle online \n \n \n \nCorresponding Information:  \nBehnaz Nouri, \nThe Preventative Gynecology Research \nCenter, Shahid Beheshti  University of \nMedical Sciences, Tehran, Iran \n \nEmail: b.nouri1376@gmail.com \n \n \nCopyright © 2024, This is an original open-access article distributed under the terms of the Creative Commons Attribution-noncommercial 4.0 International License \nwhich permits copy and redistribution of the material just in noncommercial usages with proper citation. \n \n \nIntroduction\nEndometriosis is a condition in which tissue similar \nto the lining of the uterus grows outside of it, resulting \nin symptoms such as chronic pelvic pain, painful \nperiods, painful intercourse, and infertility (1-5). \nEndometriosis is a common gynecological disorder \naffecting an estimated 10% of reproductive -aged \nwomen worldwide, with higher rates reported in \ninfertile women (4-9). It is characterized by the growth \nof endometrial tissue outside the uterus, causing \nchronic pelvic pain, dysmenorrhea, dyspareunia, and \ninfertility (7-11). The economic burden of \nendometriosis is substantial, with estimated annual \nhealthcare costs of $119 billion globally (3). \nIn the United States, the prevalence of endometriosis \nis estimated to be between 6 -10% of women of \nreproductive age (8-12). With an annual incidence rate \nof 1 -2% (5). In Iran, the reported prevalence of \nendometriosis varies widely, ranging from 2% to 40% \nof women of reproductive age (6, 7). \nDespite the high prevalence and significant impact of \nendometriosis on the quality of life and economic \nproductivity of affected women, there is still a limited \nunderstanding of the epidemiology and risk factors for \nthe condition, particularly in the context of Iran (10-\n13). This lack of knowledge and awareness about \nendometriosis in Iran can lead to underdiagnosis, \ndelayed diagnosis, and inadequate treatment, resulting \nin unnecessary suffering and long -term complications \nfor women (14-16). Therefore, identifying the \nepidemiological patterns and risk factors for \nendometriosis in Iranian women is essential for \nimproving diagnosis and management strategies, \nenhancing public health awareness, and ultimately \nreducing the burden of the disease on individuals and \nsociety (9, 17).  \n \nMethods \nThis study is a descriptive studyperformed on \nendometriosis Iranian women who referred to \n\n\nBehnaz Nouri et al. 336 \n      Volume 9, May – June 2024       Journal of Obstetrics, Gynecology and Cancer Research \nShohadayeTajrish Hospital affiliated to Shahid \nBeheshti University of Medical Sciences, Tehran, Iran \nbetween 2016 and 2022. The study was approved by \nthe Ethics Committee of Shahid Beheshti University of \nMedical Sciences (IR.SBMU.MSP.REC.1395.362). \nThe sample size of this study was determined using the \ncensus method, and 711 patients diagnosed with \nendometriosis were included in this study. \nAll patients diagnosed with endometriosis by \nultrasound, MRI, or surgery were included in the study. \nDemographic and clinical data of patients, such as age, \nbody mass index, place of residence, education level, \nmarital status, type of pregnancy, and its outcome were \ncollected by a single interviewer through face -to-face \ninterviews at the outpatient clinic after the diagnosis of \nendometriosis was confirmed. The data were entered \ninto an Excel spreadsheet and analyzed using statistical \nmethods. \nFor analyzing used SPSS software version 22, and \nresults were reported as mean ± SD. \n \nResults \nFinally, 711 patients enrolled in this study and the \naverage age of patients was 34.69± 7.53 years (min:14 \nand max:55) and the mean age of onset of disease was \n29.97±4.61(min: 16 and max 54). Table 1\n shows \ndescriptive characteristics of patients.  \n \nTable 1. Epidemiological and Demographical Characters \nCharacters Frequency \nMarriage status \nSingle \nMarried /relationship \n \n151 (21.23%) \n560 (78.76%) \nOccupational status \nUnemployed \nEmployed \n \n464(65.26%) \n247 (34.74%) \nEducational status \nIlliterate \nDiploma \nBachelor \nMaster and doctorate \n \n14 (1.97%) \n150 (21.10%) \n326 (45.85%) \n221 (31.08%) \nBMI \n<18.5 (underweight) \n18.5 to <25 (healthy weight) \n25.0 to <30 (overweight) \n30 to < 35 (Class 1) \n35 to < 40 (Class 2) \n24.88±3.94 \n17.51± 0.65 (n=33, 4.64%) \n22.72± 1.80(n=392, 55.13%) \n27.65± 1.36(n=229, 32.21%) \n32.45± 1.25(n=53, 7.45%) \n39.25± 1.29(n=4, 0.57%) \nPlace of living \nCapital \nCounty \nVillage \nAbroad \n \n309 (43.46%) \n289 (40.65) \n109 (15.33%) \n4 (0.56%) \nFamily History \nYes \nNo \n \n60 (8.43%) \n651 (91.57%) \nHistory of Pregnancy \nYes \nNo \n \n505 (71.02%) \n206 (28.98%) \nHistory of Infertility  \n\n337 Epidemiology of Endometriosis \n      Volume 9, May – June 2024       Journal of Obstetrics, Gynecology and Cancer Research \nCharacters Frequency \nYes \nNo \n126 (17.72%) \n585 (82.28%) \nHistory of Abortion \nYes \nNo \n \n111 (15.61%) \n600 (84.39%) \nEctopic pregnancy \nYes \nNo \n \n9 (2.27%) \n702 (98.73%) \nHistory of death uterine \nYes \nNo \n \n21(2.96%) \n                                   690(97.04%) \n \nDiscussion \nCardoso-1 and colleagues from Argentina, in a \nretrospective study of 237 patients over 6 years, \nexamined the demographic factors of age [29-39], body \nmass index [18.5- 24.9], and symptoms. The average \ntime to diagnosis was 5 years. Endometrioma and deep \ninfiltrating endometriosis (DIE) had the highest \nprevalence (17). In study Eisenberg, Weil (18)  which \nexamined the epidemiology of endometriosis based on \ndata from 2 million participants, the prevalence age \nwas 40-44 with an average age of 34, and infertility was \npresent in 37% of patients (18). Al-Jefout, Alnawaiseh \n(19) from the University of Arabia in 2018 reported a \nprevalence of endometriosis of 1.5% in a study of 3572 \nindividuals with an average age of 20 -29 and irregular \nand long menstrual periods of equal to or greater than \n7 days. Endometriosis was reported more in divorced \nindividuals (19). Parasar, Ozcan and Terry (20)  study \nfrom Boston Women's Hospital in 2017 reported that \nearly menarche, short menstrual periods, higher height \nto waist ratio, and higher body mass index are \nassociated with a higher incidence of endometriosis. \nPregnancy, higher body mass index, and smoking \nreduce the incidence of the disease (20) . Alshammari, \nAlrajhi (21) reported on a retrospective cohort study of \n460 patients who presented to a university hospital over \n5 years, with an average age of 31.9 years and a peak \nincidence of 35 –45 years. The incidence was l ess in \npregnant patients and those who had undergone \ncesarean section (21) . In their literature review, \nSmolarz, Czerw (22)  found that 10- 15% of women in \nthe peak age range of 25 -45 have endometriosis, and \n7% have a family history of the disease. It is diagnosed \nin 20% of women during tubal ligation and in 17% after \noophorectomy surgery. It has the highest prevalence in \nAsian women and the lowest in Black women (22-24).  \n \nConclusion \nEndometriosis patients’ life in many aspects, \nincluding their job, lifestyl e, education, marital status, \npregnancy and childbirth and health care is affected. \nAcknowledgments \nNone. \n \nAuthors' Contribution \nStudy concept and design: BN and SN; Drafting of \nthe manuscript: BN and SN; Critical revision of the \nmanuscript: BN and MA; Statistical analysis: SN. All \nthe authors have given final approval of the version to \nbe published. \n \nConflict of Interest \nThe authors certify that they have no affiliations with \nor involvement in any organization or entity with any \nfinancial or non- financial interest in the subject or \nmaterials discussed in the manuscript. \n \nData Reproducibility \nThe data set presented in the study is available on \nrequest from the corresponding author during \nsubmission or after its publication. \n \nEthical Approval \nThis study was approved by the ethical committee of \nShahid Beheshti University of Medical Sciences, \nTehran, Iran. \n \nFunding/Support \nThe author(s) received no financial support for the \nresearch, authorship, and/or publication of this article. \n \nInformed Consent \nAll participants filled out and signed an informed \nconsent form to participate in the study. \n\nBehnaz Nouri et al. 338 \n      Volume 9, May – June 2024       Journal of Obstetrics, Gynecology and Cancer Research \n \n1. Vercellini P, Viganò P, Somigliana E, Fedele L. \nEndometriosis: pathogenesis and treatment. Nat \nRev Endocrinol. 2014;10(5):261-75.  \n[DOI:10.1038/nrendo.2013.255] [PMID] \n2. Johnson NP, Hummelshoj L. Consensus on current \nmanagement of endometriosis. Hum Reprod. 2013; \n28(6):1552-68. [DOI:10.1093/humrep/det050]  \n[PMID] \n3. Nnoaham KE, Hummelshoj L, Webster P, \nd'Hooghe T, de Cicco Nardone F, de Cicco \nNardone C, et al. Impact of endometriosis on \nquality of life and work productivity: a multicenter \nstudy across ten countries. Fertil Steril. 2011;96(2): \n366-73.e8. [ DOI:10.1016/j.fertnstert.2011.05.090] \n[PMID] [PMCID] \n4. Moradi M, Niazi A, Parker M, Sneddon A, Lopez \nV, Ellwood D. Endometriosis -associated \nSymptoms and Diagnostic Delay: An Online \nSurvey. J Obstet Gynecol Cancer Res. 2022;7(6):  \n479-88. [DOI:10.30699/jogcr.7.6.479] \n5. Burney RO, Giudice LC. Pathogenesis and \npathophysiology of endometriosis. Fertil Steril. \n2012;98(3):511-9. [PMID] [PMCID]  \n[DOI:10.1016/j.fertnstert.2012.06.029]  \n6. Mollazadeh S, Mirzaii Najmabadi K, \nMirghafourvand M, Latifnejad Roudsari R. Sexual \nActivity during Menstruation as A Risk Factor for \nEndometriosis: A Systematic Review and Meta -\nAnalysis. Int J Fertil Steril. 2023;17(1):1-6. \n7. Akbarzadeh-Jahromi M, Shekarkhar G, Sari Aslani \nF, Azarpira N, Heidari Esfahani M, Mo mtahan M. \nPrevalence of Endometriosis in Malignant \nEpithelial Ovarian Tumor. Arch Iran Med. 2015;  \n18(12):844-8. \n8. Davoodi P, J. Ghadimi D, Rezaei M, Khazei Tabari \nMA, Shirani A, Nouri B, et al. Endometriosis and \nCOVID-19: Clinical Presentation and Quality of  \nLife, a Systematic Review. J Obstet Gynecol \nCancer Res. 2023;8(4):315-26.  \n[DOI:10.30699/jogcr.8.4.315] \n9. Nouri B, Arab M, Nasiri M. Endometriosis: \nClinical, Magnetic Resonance Imaging and \nPathologic Findings. J Obstet Gynecol Cancer Res. \n2023;8(5):481-7. [DOI:10.30699/jogcr.8.5.481] \n10. Moazzami B, Chaichian S, Samie S, Zolbin MM, \nJesmi F, Akhlaghdoust M, et al. Does \nendometriosis increase susceptibility to COVID-19 \ninfections? A case- control study in women of \nreproductive age. BMC Womens Health. 2021;  \n21(1):119. [ DOI:10.1186/s12905-021-01270-z] \n[PMID] [PMCID] \n11. Hoorsan H, Alavi Majd H, Chaichian S, \nMehdizadehkashi A, Hoorsan R, Akhlaqghdoust \nM, et al. Maternal An thropometric Characteristics \nand Adverse Pregnancy Outcomes in Iranian \nWomen: A Confirmation Analysis. Arch Iran Med. \n2018;21(2):61-6. \n12. Sarbazi F, Akbari E, Nouri B. Pain Management in \nEndometriosis. Interv Pain Med Neuromod. \n2022;2(1):e128043. [DOI:10.5812/ipmn-128043] \n13. Sarbazi F, Akbari E, Karimi A, Nouri B, Noori \nArdebili SH. The Clinical Outcome of \nLaparoscopic Surgery for Endometriosis on Pain, \nOvarian Reserve, and Cancer Antigen 125 (CA -\n125): A Cohort Study. Int J Fertil Steril. 2021;  \n15(4):275-9. \n14. Nouri B, Roshandel S. Is Artificial Intelligence a \nNew Diagnostic Approach for Patients with \nEndometriosis? Interv Pain Med Neuromod. 2022;  \n2(1):e128720. [DOI:10.5812/ipmn-128720] \n15. Hoorsan H, Mirmiran P, Chaichian S, Moradi Y, \nAkhlaghdoust M, Hoorsan R, et al. Diet and risk of \nendometriosis: a systematic review and meta -\nanalysis study. Iran Red Crescent Med J. 2017;  \n19(9):e41248. [DOI:10.5812/ircmj.41248] \n16. Nouri B, Baghestani AR, Pooransari P. Evening \nPrimrose versus Misoprostol for Cervical \nDilatation before Gynecologic Surgeries; a Double-\nblind Randomized Clinical Trial. J Obstet Gynecol \nCancer Res. 2021;6(2):87-94.  \n[DOI:10.30699/jogcr.6.2.87] \n17. Reza M, Mohsen M, Ansari A. In: Endometriosis \n[Internet]. Endometriosis - Basic Concepts and \nCurrent Research Trends. InTech; 2012. Available \nfrom: [DOI:10.5772/32760] \n18. Eisenberg VH, Weil C, Chodick G, Shalev V. \nEpidemiology of endometriosis: a large population-\nbased database study from a healthcare provider \nwith 2 million members. BJOG. 2018;125(1):55-\n62. [DOI:10.1111/1471-0528.14711] [PMID] \n19. Al-Jefout M, Alnawaiseh N, Ajarmeh H, Alqudah \nM. Prevalence and clinical presentation of \nendometriosis among women with infertility or \nchronic pelvic pain at a university hospital in \nJordan. Int J Womens Health. 2018(10):11-7. \n20. Parasar P, Ozcan P, Terry KL. Endometriosis: \nEpidemiology, Diagnosis and Clinical \nManagement. Curr Obstet Gynecol Rep. 2017;6(1): \n34-41. [DOI:10.1007/s13669-017-0187-1] [PMID] \n[PMCID] \n21. Alshammari SM, Alrajhi NN, Al -Rumayh SS, \nAlosaimi MA, Alsharyufi RM, Bukhari YS, et al. \nAn Overview on Pelvic Inflammatory Disease \nDiagnosis and Management Approach. Arch Pharm \nPract. 2021;12(2):103-5.  \n[DOI:10.51847/1jlwKjj2kw] \nReferences \n\n339 Epidemiology of Endometriosis \n      Volume 9, May – June 2024       Journal of Obstetrics, Gynecology and Cancer Research \n22. Smolarz B, Czerw A, Szymanowski K, Kaminski \nP. Endometriosis - a comprehensive review of \nepidemiology, pathogenesis, clinical a spects and \navailable therapeutic methods. Arch Med Sci. \n2021;17(6):1404-18. \n23. Nouri B, Hashemi SH, Ghadimi Dj, Roshandel S, \nAkhlaghdoust M. Machine Learning in the \nDetection of Endometriosis: Retrospective Study. \nInt J Fertil Steril. 2024; (Articles in Press). \n24. Nouri B, Alemi M, Baghestani AR. The Effect of \nLaparoscopic Radical Surgery for Endometriosis \non Serum Levels of Lipid Profile and Vitamin D. J \nObstet Gynaecol Cancer Res. 2022;7(5):429- 36. \n[DOI:10.30699/jogcr.7.5.429] \n \n \nHow to Cite This Article:  \nNouri, B., Naz Agili, S., Arab, M. Endometriosis: A SixYear Epidemiological Study. J Obstet Gynecol Cancer Res. \n2024;9(3):335-9. \nDownload citation:                             RIS | EndNote | Mendeley |BibTeX |","source_license":"CC0","license_restricted":false}