{"paper_id":"f7e2ddc7-7f4e-4939-8c0f-f2d4ba05ed0f","body_text":"~ 1003 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2026; 10(2): 1003-1006 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \nIndexing: Embase \nImpact Factor (RJIF): 6.71 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2026; 10(2): 1003-1006 \nReceived: 21-01-2026 \nAccepted: 23-02-2026 \n \nFatema Khatun  \nMedical Officer (Gynae & Obs), \n250-Bedded General Hospital, \nPabna, Bangladesh \n \nMohammad Akshad Al Masur  \nSenior Consultant, Department of \nOrthopaedic Surgery, 250-Bedded \nGeneral Hospital, Pabna, \nBangladesh \n \nMd. Sarwar Jahan  \nAssociate Professor (Spine \nSurgery), National Institute of \nTraumatology and Orthopaedic \nRehabilitation (NITOR), Dhaka, \nBangladesh \n \nSharif Ahmed Jonayed \nAssociate Professor (Spine \nSurgery), National Institute of \nTraumatology and Orthopaedic \nRehabilitation (NITOR), Dhaka, \nBangladesh \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nFatema Khatun  \nMedical Officer (Gynae & Obs), \n250-Bedded General Hospital, \nPabna, Bangladesh \n \nClinicopathological profile and risk factors of \nendometriosis among reproductive-aged women \nattending a tertiary care hospital: A study of 100 cases \n \nFatema Khatun , Mohammad Akshad Al Masur , Md. Sarwar Jahan  and \nSharif Ahmed Jonayed \n \nDOI: https://www.doi.org/10.33545/gynae.2026.v10.i2m.2153  \n \nAbstract \nBackground: Endometriosis is a chronic , estrogen-dependent inflammatory gynecological disorder \ncharacterized by the presence of endometrial glands and stroma outside the uterine cavity. It pre dominantly \naffects women of reproductive age and is a major cause of dysmenorrhea , chronic pelvic pain and \ninfertility. Despite its increasing recognition worl dwide, limited data exist regarding its clinicopathological \nprofile and associated risk factors in peripheral tertiary care settings in Bangladesh. \nObjective: To evaluate the clinicopathological characteristics and identify risk factors of endometriosis \namong reproductive-aged women attending a tertiary care hospital in Pabna, Bangladesh. \nMethods: This hospital -based cross -sectional observational study included 100 diagnosed cases of \nendometriosis from January to December 2024. Diagnosis was confirmed by ultrasonography, laparoscopy, \nlaparotomy, and histopathological examination. Data regarding socio-demographic profile , menstrual \ncharacteristics, reproductive history, clinical presentation, operative findings and histopathological results \nwere collected using a structured questionnaire. Statistical analysis was performed using SPSS version 26. \nResults: The mean age of patients was 29.8 ±5.6 years. The majority (62%) were aged 21- 30 years. \nDysmenorrhea (82%) was the most common symptom , followed by chronic pel vic pain (65%) and \ninfertility (54%). Ovarian endometrioma was the most frequent anatomical site (58%). Early menarche \n(<12 years) was observed in 38% cases , nulliparity in 60% and positive family history in 18%. Advanced \nstage (Stage III- IV) disease was f ound in 46% of patients. Histopathology confirmed endometriosis in all \nsurgically treated cases. \nConclusion: Endometriosis significantly affects young reproductive -aged women, with dysmenorrhea and \ninfertility being predominant presentations. Early menarche, nulliparity and prolonged menstrual flow were \nsignificant risk factors. Early diagnosis and timely intervention are essential to reduce morbidity and \nimprove reproductive outcomes. \n \nKeywords: Endometriosis, Reproductive-aged women, Dysmenorrhea, Chronic pelvic pain, Infertility, \nOvarian endometrioma, Risk factors, rASRM staging, Clinicopathological profile, Bangladesh. \n \nIntroduction  \nEndometriosis is defined as the presence of functional endometrial glands and stroma outside the \nuterine cavity [1]. It is  a chronic inflammatory and estrogen -dependent condition that affects \napproximately 10 -15% of women of reproductive age worldwide [2]. Among women with \ninfertility, its prevalence may rise to 30 -50% [3]. Despite its high prevalence , endometriosis \nremains u nderdiagnosed, particularly in developing countries due to limited awareness and \ndiagnostic facil ities [4]. The pathogenesis of endometriosis remains controversial. Several \ntheories have been proposed including Sampson’s theory of retrograde menstruation, coelomic \nmetaplasia, stem cell theory  and lymphovascular dissemination [5]. Retrograde menstruation is \nthe most widely accepted mechanism , where menstrual debris flows backward through the \nfallopian tubes into the pelvic cavity and implants on peritoneal s urfaces [6]. However, since \nretrograde menstruation occurs in many women without disease developm ent, genetic \npredisposition and immunological dysfunction are thought to contribute significantly [7]. \nEndometriosis commonly involves ovaries, uterosacral ligaments, pouch of Douglas, and pelvic \nperitoneum [8]. Ovarian endometrioma , also known as “chocolate cyst ,” represents one of the \nmost frequent forms [9]. Clinically , it presents with dysmenorrhea , chronic pelvic pain , \ndyspareunia, and infertility [10]. The severity of symptoms does not always correlate with  \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1004 ~ \ndisease stage [11]. The revised American Society for \nReproductive Medicine (rASRM) classification categorizes \nendometriosis into four stages (I -IV) based on lesion size , depth \nand adhesions [12]. Diagnosis is primarily clinical and supported \nby imaging modalities such as transvaginal ultrasonography and \nMRI. However, laparoscopy with histopathological confirmation \nremains the gold standard \n[13]. Several risk factors have been \nidentified including early  menarche, short menstrual cycles , \nheavy menstrual bleeding, nulliparity, low body mass index and \npositive family history [14]. Protective factors include multiparity, \nprolonged lactation and use of combined oral contraceptive pills \n[15]. In Bangladesh , data regarding clinicopathological patterns \nand risk factors of endometriosis are limited , especially outside \nmajor metropolitan centers. Understanding the local \ndemographic distribution , clinical presentation  and associated \nrisk factors is essential for imp roving diagnostic suspicion and \nmanagement strategies. This study was conducted at the \nDepartment of Gynaecology and Obstetrics , 250 Bedded \nGeneral Hospital , Pabna, to evaluate the clinicopathological \nprofile and identify risk factors among reproductive -aged \nwomen diagnosed with endometriosis during 2024. \n \nMethods \nThis hospital -based cross -sectional observational study was \nconducted in the Department of Gynaecology and Obstetrics , \n250 Bedded General Hospital, Pabna, Bangladesh, from January \n2024 to December 2024. \n \nStudy Population \nA total of 100 reproductive -aged women (18 -45 years) \ndiagnosed with endo metriosis were included. Diagnosis was \nmade based on clinical features , ultrasonography, operative \nfindings (laparoscopy or laparotomy)  and confirmed by \nhistopathological examination wherever tissue was obtained. \n \nInclusion Criteria \n• Women aged 18-45 years \n• Clinically suspected and surgically or radiologically \nconfirmed cases of endometriosis \n• Willing to provide informed consent \n \nExclusion Criteria \n• Women with pelvic inflammatory disease \n• Gynecological malignancy \n• Adenomyosis without evidence of endometriosis \n• Incomplete medical records \n \nData Collection \nData were collected using a structured questionnaire and hospital \nrecords. Variables included: \n• Socio-demographic characteristics \n• Age at menarche \n• Menstrual cycle pattern and duration \n• Parity status \n• Family history \n• Clinical symptoms \n• Infertility history \n• Imaging findings \n• Operative staging (rASRM classification) \n• Histopathological findings \n \nStatistical Analysis \nData were entered and analyzed using SPSS version 26. \nQuantitative data were expressed as mean  ± standard deviation. \nCategorical variables were presented as frequency and \npercentage. Associations between risk factors and severity were \nanalyzed using chi -square test. A p -value <0.05 was considered \nstatistically significant. \n \nEthical Consideration \nEthical approval was obtained from the hospital ethical review \ncommittee. Informed written consent was taken from all \nparticipants. \n \nResults  \nA total of 100 reproductive -aged women dia gnosed with \nendometriosis were included in this study. \n \nTable 1: Age Distribution of Patients (n=100) \n \nAge Group (years) Frequency Percentage \n18-20 8 8% \n21-30 62 62% \n31-40 25 25% \n41-45 5 5% \nTotal 100 100% \n \nThe majority of patients belonged to the 21 -30 years age group , \naccounting for 62% of cases , indicating that endometriosis \npredominantly affected young reproductive -aged women in this \ncohort. The second most affected group was 31- 40 years (25%). \nOnly 8% were between 18 -20 years  and 5% were aged 41 -45 \nyears. The mean age of the study population was 29.8±5.6 years, \nreflecting peak disease occurrence in the late twenties. \n \nTable 2: Presenting Symptoms of Endometriosis (n=100) \n \nSymptom Frequency Percentage \nDysmenorrhea 82 82% \nChronic pelvic pain 65 65% \nInfertility 54 54% \nDyspareunia 40 40% \nMenorrhagia 36 36% \nIrregular menstruation 28 28% \nPelvic mass 22 22% \n \nDysmenorrhea was the most common presenting complaint , \nreported by 82% of patients , making it the hallmark symptom in \nthis study. Chronic pelvic pain was present in 65% of cases , \nhighlighting the significant burden of persistent pain among  \naffected women. Infertility was observed in 54% of patients , \nemphasizing the reproductive implications of the disease. \nDyspareunia was reported in 40% of wome n, while menorrhagia \noccurred in 36%. Irregular menstruation was noted in 28%  and \n22% presented with a palpable pelvic mass , commonly \nassociated with ovarian endometrioma. \n \nTable 3: Menstrual and Reproductive Risk Factors (n=100) \n \nRisk Factor Frequency Percentage \nEarly menarche (<12 years) 38 38% \nNulliparity 60 60% \nParity ≥1 40 40% \nCycle length <27 days 42 42% \nMenstrual flow >5 days 48 48% \nFamily history of endometriosis 18 18% \nHistory of infertility 54 54% \n \nAmong reproductive risk factors , nulliparity was found in 60% \nof patients, suggesting a strong associatio n between absence of \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1005 ~ \nchildbirth and endometriosis. Early menarche before 12 years of \nage was observed in 38% of cases. Short menstrual cycles (<27 \ndays) were present in 42% and prolonged menstrual bleeding \n(>5 days) in 48% , both of which may increase expos ure to \nretrograde menstruation. A positive family history of \nendometriosis was identified in 18% of patients , indicating \npossible genetic predisposition. More than half (54%) of the \nstudy population had a history of infertility. \n \nTable 4: Anatomical Distribution of Endometriotic Lesions (n=100) \n \nSite of Lesion Frequency Percentage \nOvary 58 58% \nUterosacral ligament 15 15% \nPouch of Douglas 12 12% \nPelvic peritoneum 10 10% \nRectovaginal septum 3 3% \nOthers 2 2% \nTotal 100 100% \n \nOvarian involvement was the most common anatomical site , \nseen in 58% of patients , predominantly presenting as ovarian \nendometrioma (chocolate cyst). Uterosacral ligament \ninvolvement accounted for 15% of cases , while 12% had lesions \nin the pouch of Douglas. Pelvic peritoneal deposits were \nobserved in 10% of women. Less commonly , rectovaginal \nseptum involvement was found in 3% , and other rare sites \naccounted for 2%. This distribution indicates a predominance of \novarian disease in this population. \n \nTable 5: Stage of Endometriosis According to rASRM Classification \n(n=100) \n \nStage Frequency Percentage \nStage I (Minimal) 18 18% \nStage II (Mild) 36 36% \nStage III (Moderate) 28 28% \nStage IV (Severe) 18 18% \nTotal 100 100% \n \nBased on the revised American Society for Reproductive \nMedicine (rASRM) classification, Stage II (mild) endometriosis \nwas the most common, accounting for 36% of cases. Stage III \n(moderate) disease was observed in 28% of patients. Minimal \ndisease (Stage I) was present in 18% , while severe disease \n(Stage IV) was also seen in 1 8%. Overall , advanced stages \n(Stage III and IV combined) constituted 46% of cases, indicating \na considerable proportion of women presented with moderate to \nsevere disease. \n \nTable 6: Histopathological Confirmation (n=100) \n \nHistopathological Finding Frequency Percentage \nConfirmed endometriosis (glands + stroma) 92 92% \nEndometriotic cyst (ovarian) 58 58% \nFibrosis with hemosiderin-laden macrophages 46 46% \nDeep infiltrating endometriosis 12 12% \n \nHistopathological examination confirmed the presence of both  \nendometrial glands and stroma in 92% of surgically treated \nspecimens. Ovarian endometriotic cysts were identified in 58% \nof cases , correlating with the clinical findings. Fibrosis with \nhemosiderin-laden macrophages , indicative of repeated \nhemorrhage, was present in 46% of specimens. Deep infiltrating \nendometriosis was observed in 12% of patients , representing \nmore aggressive disease. \n \nDiscussion \nThis hospital -based cross -sectional study evaluated the \nclinicopathological profile and associated risk factors of \nendometriosis among reproductive -aged women attending a \ntertiary care hospital in Pabna , Bangladesh. The findings \ndemonstrate that endometriosis predominantly affects young \nwomen in their most productive and reproductive years , with \nsignificant implications for pain, fertility and quality of life. In \nthe present study , the mean age of the patients was 29.8 ±5.6 \nyears, and the majority (62%) belonged to the 21- 30 years age \ngroup. This observation is consistent with global \nepidemiological data indicating th at endometriosis most \ncommonly affects women between 25 and 35 years of age \n[2, 16]. \nThe relatively lower proportion of women above 40 years may \nbe explained by declining estrogen levels and reduced disease \nactivity with advancing age. Dysmenorrhea was the  most \ncommon presenting symptom (82%), followed by chronic pelvic \npain (65%) and infertility (54%). These findings align with \nprevious studies reporting dysmenorrhea as the hallmark \nsymptom of endometriosis \n[10, 17]. The high prevalence of chronic \npelvic p ain reflects the inflammatory nature of ectopic \nendometrial implants and associated adhesions. Infertility \nobserved in more than half of the patients underscores the strong \nassociation between endometriosis and subfertility , as reported \nin earlier research  showing prevalence rate s of 30 -50% among \ninfertile women \n[3, 18]. The mechanisms include distorted pelvic \nanatomy, adhesions, altered peritoneal environment , and \nimpaired ovulatory function. Ovarian involvement was the most \nfrequent anatomical site (58%) , predominantly presenting as \novarian endometrioma. This finding is consistent with other \nstudies indicating the ovary as the most common location of \nendometriotic lesions [9, 19]. The predilection for ovarian tissue \nmay be related to repeated ovulation and  local hormonal \ninfluences. Uterosacral ligament and pouch of Douglas \ninvolvement were also observed , reflecting the typical posterior \npelvic distribution described in the literature [8]. According to the \nrevised American Society for Reproductive Medicine (rASRM) \nclassification, Stage II disease was most common (36%) , while \nadvanced stages (Stage III and IV) comprised 46% of cases. The \nrelatively high proportion of moderate to severe disease suggests \ndelayed diagnosis , which may be due to lack of awareness , \nnormalization of menstr ual pain and limited access to advanced \ndiagnostic facilities in peripheral settings \n[4, 20]. Importantly , \nsymptom severity did not always correlate with disease stage, \nsupporting previous observations that minimal disease can \nproduce severe pain , while advanced disease may remain \nasymptomatic [11]. Regarding risk factors , nulliparity was \nidentified in 60% of patients , reinforcing the hypothesis that \nuninterrupted menstrual cycles increase exposure to retrograde \nmenstruation and impl antation of endometrial cells [6, 14]. Early \nmenarche (<12 years) was present in 38% of cases , suggesting \nprolonged lifetime estrogen exposure as a contributing factor. \nShort menstrual cycles and prolonged menstrual flow were also \ncommon, both of which have been associated with increased \nretrograde menstruation and disease risk [14]. A positive family \nhistory in 18% of cases indicates a possible genetic \npredisposition, consistent with evidence demonstrating familial \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1006 ~ \naggregation and higher concordance among first-degree relatives \n[7, 21]. Histopathological examination confirmed the diagnosis in \nthe majority of cases , demonstrating endometrial glands and \nstroma along with hemosiderin- laden macrophages , a classical \nfeature of the disease. Deep infiltrating endo metriosis observed \nin a subset of patients reflects more aggressive pathology and \nmay contribute to severe pain and fertility impairment. The \nstudy has certain limitations. Being a single -center hospital -\nbased study , it may not represent the general popula tion. \nAdditionally, the sample size was relatively small and long-term \nfollow-up outcomes were not assessed. However , this research \nprovides valuable regional data that contribute to understanding \nthe clinicopathological characteristics of endometriosis in  a \nperipheral tertiary care setting in Bangladesh. Overall , the \nfindings highlight the importance of early recognition of \nsymptoms such as dysmenorrhea and chronic pelvic pain, \nparticularly among nulliparous women with early menarche and \nabnormal menstrual  patterns. Increased awareness among \nhealthcare providers and patients may facilitate earlier diagnosis \nand timely management, ultimately improving quality of life and \nreproductive outcomes. \n \nConclusion \nEndometriosis predominantly affects young reproductiv e-aged \nwomen and commonly presents with dysmenorrhea , chronic \npelvic pain , and infertility. Ovarian involvement is most \nfrequent. Nulliparity , early menarche and prolonged menstrual \nbleeding are important risk factors. Increased awareness , early \ndiagnosis, and timely management are essential to reduce \nmorbidity and improve reproductive outcomes in Bangladesh. \n \nSource of Funding \nThis research received no external funding. \n \nConflict of Interest \nThe authors declare no conflict of interest. \n \nAcknowledgement \nThe authors express their sincere gratitude to the Department of \nGynaecology and Obstetrics , 250 Bedded General Hospital , \nPabna, Bangladesh, for providing the opportunity and necessary \ninstitutional support to conduct this study. \nWe are thankful to all the pa tients who willingly participated in \nthis research and s hared their clinical information. Their \ncooperation made this study possible. \nThe authors also acknowledge the contribution of the operating \ntheatre staff , nursing personnel, and the pathology departm ent \nfor their assistance in specimen processing and histopathological \nconfirmation. \nFinally, we appreciate the support of hospital administration for \nfacilitating ethical approval and smooth data collection \nthroughout the study period (January-December 2024). \n \nReferences \n1. Giudice LC. Clinical practice. Endometri osis. N Engl J \nMed. 2010;362(25):2389-2398. \n2. Zondervan KT, Becker CM, Missmer SA. Endometriosis. \nLancet. 2020;397(10276):839-852. \n3. Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, \nTimmerman D, D’Hoogh e T. High prevalence of \nendometriosis in infertile women with normal ovulation and \nnormospermic partners. Fertil Steril. 2009;92(1):68-74. \n4. Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. \nImpact of endometriosis on women’s lives: A qualitative \nstudy. 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Clinicopathological \nprofile and risk factors of endometriosis among reproductive- aged women \nattending a tertiary  care hospital: A study of 100 cases . International \nJournal of Clinical Obstetrics and Gynaecology 2026; 10(2): 1003-1006.  \n \n \n \nCreative Commons (CC) License \nThis is an open access journal, and articles are distributed under the terms \nof the Creative Commons Attribution -Non Commercial-Share Alike 4.0 \nInternational (CC BY-NC-SA 4.0) License, which allows others to remix , \ntweak, and build upon the work non- commercially, as long as appropriate \ncredit is given and the new creations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}