Endometriosis: Clinical Experience of 500 Patients from India

Background/Purpose of Study: Endometriosis, a common, chronic, gynecological condition, has a burden of around 176 million women globally and ∼26 million women alone in India. It is associated with chronic pelvic pain, subfertility, dysmenorrhea and dyspareunia. Information about clinical phenotype of endometriosis is lacking in India. Additionally, the correlation between the symptoms and different characteristics of endometriosis has not been estimated in the Indian population yet. In the present study, we aimed to investigate the clinical phenotype of women with endometriosis and to describe the unusual cases of endometriosis. Methods: Clinical phenotype of endometriosis was studied in a total of 500 women with endometriosis. Results: Out of 500 cases, 87 (15%) of endometriosis cases were classified as Peritoneal, 291 (58%) as ovarian and 122 (24%) were having deep infiltrating endometriosis (DIE/RV). The disease was classified into Stage I-II (n=183) and Stage III-IV (n=317) as per the revised American Society for Reproductive Medicine (rASRM). In the cohort of women with endometriosis, 77% women experienced dysmenorrhea, 23% dyspareunia, 34% chronic pelvic pain and 14% suffered from dyschezia. Around 13% women had family history of endometriosis. Sixty six percent women either had primary or secondary infertility and 33% had history of miscarriage. We also detected endometriosis having unusual presentation such as endometriosis associated endometrioid type of ovarian cancer, cervical endometriosis, endometriosis associated with didelphys uterus. Conclusion: The incidence of endometriosis is rising in India and hence there is a need to develop uniform guidelines for the diagnosis and management of endometriosis.