Prevalence of endometriosis in Puerto Rico

Objective: To establish the prevalence of endometriosis in Puerto Rico, which has not been previously studied. Design: A cross-sectional study was conducted by applying a self-administered questionnaire to 398 women aged 18 to 55 from southern Puerto Rico. Participants were identified at health fairs, universities, private companies, or shopping centers. Materials/Methods: The questionnaire inquired about gynecology and obstetrics history, and other clinical and life-style factors. Statistical analyses were conducted using proportions and percentages. Categorical variables were compared using chi-square analysis or Fisher’s exact test when appropriate. All tests were two-tailed. Alpha level was set at 0.05 for significance. Results: The majority of respondents was 20–29 years old (43%), had at least a bachelor’s degree (55.8%), and were married (52%). For 44.6% of women menarche occurred at 12–13 y/o; 62.7% had a regular cycle of 27–30 days, and 51.3% had an average length (5–6 days) of menstrual flow. A surprising majority of participants (66%) reported pain during menses. Of these 50% indicated that pain was incapacitating in nature. Dyspareunia was reported by 29.0% of participants. Of those women who had tried to conceive (63.7%), 27.5% reported having problems getting pregnant and 13% are still childless. Most women (46.4%) have 1 or 2 children, and 63.6% had their first child between 20 and 29 y/o. We identified 15 cases of endometriosis among a total of 366 questionnaires, for a point prevalence equal to 4.1%. The majority of patients were 20–29 years old (33.3%), had at least a bachelor’s degree (78.5%), and were married (73.3%). For 44.6% of patients menarche occurred at 9–11 y/o, 57.1% had a regular cycle of 27–30 days, and 46.7% had a short length (1–4 days) of menstrual flow. As expected, 86.7% of patients reported dysmenorrhea, and 63.6% reported that the pain interrupted their daily activities. For 60% of patients the pain was chronic and 64.3% reported suffering from dyspareunia. A family history of endometriosis was reported by 27.3% of the patients. Of those patients who had tried to conceive (78.6%), 54.5% reported having problems getting pregnant, 36.4% are still childless, and 42.9% reported having one abortion. Using Fisher’s Exact Test, a diagnosis of endometriosis was shown to be significantly associated with fertility problems (p < 0.05), being childless (p < 0.01), dyspareunia (p < 0.01), chronic pelvic pain (p < 0.01), ovarian cysts (p < 0.01), and hysterectomy (p < 0.01). Age, age at menarche, age at first delivery, cycle length, length of menstrual flow, use of oral contraceptives, dysmenorrhea and abortions were not significantly associated with endometriosis. Conclusions: This study established that the prevalence of endometriosis in southern Puerto Rico is 4.1%. This figure is within what has been reported in other populations (2 to 43%). We did not observe the reported associations between menstrual cycle characteristics and a diagnosis of endometriosis in our population. Significant associations were observed between endometriosis and a history of infertility, dyspareunia, chronic pelvic pain, ovarian cysts and hysterectomy. Supported By: NIH-RCMI grant # 2-G12 RR03050-16.