Epidemiology, management and diagnostic workup for endometriosis related pelvic pain

Epidemiology, management and diagnostic workup for endometriosis related pelvic pain | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiology, management and diagnostic workup for endometriosis related pelvic pain Damian Warzecha, Daria Salloum, Mirosław Wielgoś, Nicole Sochacki-Wójcicka, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3508411/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: It’s believed that around 10% of gynecology appointments are related to pelvic pain. Although in most cases the underlying etiology remains unknown, endometriosis is one of the most causes of this condition. The aim of our study was to investigate the epidemiology, diagnostic workup and management of dysmenorrhea, dyspareunia and chronic pelvic pain among women suffering from endometriosis. Methods : An electronic, anonymous questionnaire was prepared by the authors and shared by social media. Women were asked to identify the bases of the diagnosis of their endometriosis in accordance with the European Society of Human Reproduction and Embryology (ESHRE) guidelines. The study protocol included only pre-menopausal women, aged 16–56 years. 33,769 respondents took part in the survey. The credibility of completed surveys was checked to exclude the possibility of bias arising from malicious bots. The study group included 2,862 females with the diagnosis of endometriosis, according to the ESHRE guidelines. Results: The prevalence of endometriosis within the overall Polish population can be estimated at 8.7%. The mean time elapsed between the first symptoms and final confirmation of the disease was 11.8 years. The incidence and severity of all analyzed complaints was significantly higher that among the patients without previous confirmation of endometriosis (dysmenorrhea 84% vs 65.1%; dyspareunia 52.9% vs 25.5%; chronic pelvic pain 61.8% vs 25.4%) Patients suffering from endometriosis were older than the unaffected controls (33.3 vs 31.6 years, p <0.0001) and of lower BMI levels (24.0 vs 24.6, p = <0.0001) Endometriotic patients report painful symptoms to their gynecologist almost twice as often as unaffected controls suffering from any kind of pelvic pain (88.9% vs 48.7%. p < 0.0001). 27.7% of patients suffering from endometriosis experience a non-satisfactory reduction in dysmenorrhea and pelvic pain after painkillers. Conclusion: Although endometriotic patients report painful symptoms to the gynecologist almost twice as often as unaffected women, the diagnostic delay is still unacceptably long. Due to high rate of non-satisfactory reduction in dysmenorrhea and pelvic pain after taking painkillers simultaneous treatment with other options such as hormonal therapy should be introduced as early as possible. endometriosis dysmenorrhea dyspareunia pelvic pain Figures Figure 1 Background Pelvic pain is a debilitating gynecological condition that may affect up to 26% of women of childbearing age [1]. It is believed that around 10% of gynecology appointments are related to this problem [2]. Apart from strictly gynecological issues, urological, gastrointestinal and musculoskeletal factors are among the other most common causes [3]. There are several different types of pelvic pain e.g., chronic pelvic pain (CPP), dysmenorrhea, and dyspareunia. CPP by definition lasts for more than 6 months and causes a significant reduction in an individual’s quality of life and everyday functioning [4]. Although, in most cases the underlying etiology remains unknown, endometriosis, pelvic inflammatory disease, tissue hypoxia, and pelvic floor muscle weakness are mentioned as the most common causes of this condition [5]. Endometriosis is a complex disease with different clinical manifestations and variable symptomatic presentations. However, pain is often the first symptom. Endometriosis is defined as the presence of functional endometrial glands growing outside the uterus. Much of the existing epidemiological research on endometriosis has focused on characteristics of the menstrual cycle. Despite inconsistent findings, some previous research has indicated a higher risk of endometriosis with increasing exposure to menstruation. Moreover an early age at menarche, longer menstruation, and short menstrual cycles all contribute to an increased risk of endometriosis [6]. The immunological, genetic, and serum markers proposed to date for the diagnosis of endometriosis are insufficiently sensitive and specific to justify their use as a screening test [7]. The health burden of endometriosis related to chronic pain includes the considerable lifetime costs of $(US) 27,855 per patient [8]. The annual healthcare expenditures for endometriosis are roughly $22 billion in the US and £12.2 billion in the UK, encompassing treatment, loss of employment, and medical services [9]. Simoens et al., found that potential costs increase with the severity of endometriosis, the presence of pelvic pain, the presence of infertility, and the longer the duration after diagnosis [10]. The American Society for Reproductive Medicine (ASRM) classification system for endometriosis is based on the morphology, location, and size of peritoneal and pelvic implants [11]. However clinical manifestation as well as the pain intensity seem to be independent of endometriosis stages [12]. The primary objective of the presented paper was to investigate the epidemiology, management and diagnostic workup of dysmenorrhea, dyspareunia, and chronic pelvic pain in a population of Polish women suffering from endometriosis. The secondary aim of the study was to establish the phenotypic pattern and incidence of other comorbidities in affected individuals. Methods A case controlled cross-sectional study was performed between April and May 2021. An electronic, anonymous questionnaire was prepared by the authors and shared by social media. The survey was developed for a Polish-speaking audience; however an English language version of the questionnaire was also prepared. The questionnaire asked for sociodemographic and medical information from the participants. The following sections concerned the duration, severity and treatment of symptoms related to pelvic pain and dysmenorrhea. Women were asked to identify the bases of the diagnosis of their endometriosis in accordance with the European Society of Human Reproduction and Embryology (ESHRE) guidelines, based on laparoscopic or ultrasound findings (adenomyosis, deep-infiltrating endometriosis, or ovarian endometrioma). Women with the suspicion of endometriosis, and who had neither surgical nor ultrasound confirmation, were not included in our further analysis of endometriotic patients. The study protocol included only pre-menopausal women, aged 16–56 years. The original questionnaire is available as supplementary material. The study was performed in accordance with the requirements of the Declaration of Helsinki for Medical Research involving Human Subject. Ethical approval was obtained from the Ethics Committee of the Medical University of Warsaw (Reference: AKBE/119/2018). The significance of differences between the studied groups was tested with the Mann-Whitney U test for tied ranks, and the effect size was estimated using η2 (eta_square). For qualitative variables, numbers and their percentage share in subgroups were counted. The relationship between the occurrence of endometriosis and qualitative features was analyzed using the χ2p test (Pearson's chi-square), and the effect size using ϕC (Cramer's phi) (2x2 tables) and VC (Cramer's V). P-values below the 0.05 threshold were considered significant. In order to maintain the level of significance assumed for the entire study, a conservative Bonferroni correction was applied. Statistica 13.1 software (StatSoft Poland, Cracow, Poland) was used for statistical analyses. Results 33,769 respondents took part in the survey. The credibility of completed surveys was checked to exclude the possibility of bias arising from malicious bots. 346 records were excluded from further analysis due to incomplete or unreliable data. A further 370 surveys were withdrawn as the respondents were postmenopausal. The mean age of respondents was 31.8 years old (SD = 5.93). Most had a normal BMI level (18.5 – 24.9, 57.8%, mean 24.5 [kg/m2], SD = 5.05), had a higher educational level (69.4%), and were married (61.3%). The baseline characteristics of the included women who completed the internet-based survey are presented in Table 1. Table 1. Baseline characteristics of the study group Variable Age [years] M±SD Me (IQR) Min-Max 31.8 ± 5.93 31.0 (7.0) 16-56 BMI [kg/m 2 ] M±SD Me (IQR) Min-Maks 24.53±5.05 23.4 (6.2) 14.7 - 49.6 Education level N (%) Basic 247 (0.7%) Secondary 9853 (29.5%) Higher 23185 (69.4%) Studying 131 (0.4%) Marital status Married 20482 (61.3%) Partnership 9423 (28.2%) Single 2907 (8.7%) Divorced/separated 549 (1.6%) Widow 62 (0.2%) BMI – Body Mass Index, M – arithmetic mean, Me – median, Min – minimum, Max – Maximum, N – number of samples 76.7% of respondents did not suffer from any comorbidities. 23.3% reported at least one chronic disease. 2.2% two and 0.3% three or more. The most frequently indicated illnesses are presented in Table 2. Table 2. Comorbidities in the study group Comorbidities N % of answers % of cases Hypothyroidism 5093 13.52 15.06 Asthma 737 1.95 2.17 PCOS 666 1.76 1.96 Hypertension 545 1.43 1.59 Psoriasis 274 0.72 0.80 Diabetes 230 0.61 0.68 Depression 192 0.51 0.57 Neoplasm 103 0.27 0.30 Ulcerative colitis 86 0.23 0.25 PCOS – Polycystic Ovary Syndrome, N – number of samples 59.5% (19,906) of women who completed the survey had been pregnant previously. Of these, 28.0% reported having at least one miscarriage in the past. The incidence of recurrent miscarriages (3 or more consecutive pregnancy losses before the 22nd week of gestation) was 2.1%, and 2.5% had experienced at least one ectopic pregnancy. Among this group who had been pregnant previously, the fertility rate was 0.9. Vaginal delivery had been the most common form of delivery, however, 41% of the women had undergone at least one cesarean section. In general, the frequency of cesarean sections was 30.1% of all deliveries after the 22nd week of gestation. 27.6% of the total study group reported using some kind of hormonal contraceptive method. Among these, the most popular were combined oral contraceptives (61.6%), progesterone-only pills (26.4%), and levonorgestrel-releasing intrauterine devices (17.5%). Dysmenorrhea and pelvic pain Tables 3 and 4 present the incidence of dysmenorrhea and pelvic pain in general population and age at the onset. Table 3 The incidence of dysmenorrhea and pelvic pain in general population Symptom N % of participants % of participants with confirmed endometriosis Dysmenorrhea 22311 31.59 81.27 Dyspareunia 9308 13.18 33.90 Chronic pelvic pain 9542 13.51 34.76 Painful defecation 6707 9.50 24.43 Bloody stools 3348 4.74 12.19 Painful micturition 2827 4.00 10.30 Blood in the urine 857 1.21 3.12 Heavy menstrual bleeding 15732 22.27 57.30 N – number of samples Table 4. Age at the onset of dysmenorrhea or pelvic pain Age at the onset of: M N SD Min. Max. Q25 Me Q75 Dysmenorrhea 14.89 22275 4.269 9.00 51.00 12.00 13.00 16.00 Dyspareunia 23.06 6526 4.824 16.00 53.00 19.00 22.00 26.00 Chronic pelvic pain 22.1 6138 6.25 8.00 39.0 17.0 21.0 26.0 Painful defecation 22.36 4309 6.010 8.00 39.00 18.00 22.00 26.00 Bloody stools 23.89 2406 5.459 8.00 39.00 20.00 24.00 28.00 Painful micturition 21.69 1850 5.776 8.000 39.00 18.00 21.00 25.00 Blood in the urine 22.77 614 5.526 8.00 39.00 19.00 22.00 26.00 Heavy menstrual bleeding 16.72 15730 6.380 10.00 43.00 12.00 14.00 19.00 M –arithmetic mean, Me – median, N – number of samples, Q25, Me, Q75 – quartiles, SD – standard deviation Endometriosis: epidemiology, symptoms, and treatment In 2,862 (8.7%) of the respondents, endometriosis was diagnosed by laparoscopy or ultrasound. The mean age at the diagnosis was 27.4 years old (SD = 5.75, Me = 25, Min = 13.0, Max = 52.0). Most cases were confirmed by laparoscopy or laparotomy (60.8%), while endometrial cysts were the most common findings during ultrasound scans (53.2% of cases). Detailed endometriosis diagnosis data are presented in Table 5 and Graph 1. Table 5. How endometriosis was diagnosed N % of participants % of participants with confirmed endometriosis Peritoneal/DIE lesions of endometriosis on laparoscopy or laparotomy 1522 34.05 60.86 Ultrasound – endometrial cyst 1330 29.75 53.18 Ultrasound – adenomyosis 411 9.19 16.43 Ultrasound - DIE lesions 543 12.15 21.71 Ultrasound – pelvic adhesions 664 14.85 26.55 Total sample 4470 100.00 - DIE – Deep Infiltrating Endometriosis, N – number of samples, Operative diagnosis of endometriosis N % Both ways 617 41 laparoscopy 649 43 laparotomy 220 14 N/D 36 2 ∑ 1522 100 N/D - No Data Graph 1. How endometriosis was diagnosed Women suffering from endometriosis were significantly older than healthy participants, but the effect size was small (33.3, SD = 6.2 vs 31.6 y.o. SD = 5.9, Z=-13.99, p<0.0001, η 2 <0.01). Body Mass Index was statistically significantly lower among affected patients compared to controls (24.0, SD = 4.9 vs 24.6, SD = 5.0 kg/m 2 , Z=6.64, p<0.0001, η 2 =0.04). There was a statistically significant correlation between the occurrence of endometriosis and the woman’s education level, marital status, and BMI category. Table 6 Presents a comparison of baseline characteristics between patients with and without diagnosis of endometriosis. Table 6. Baseline characteristics of patients with and without endometriosis Variable Without endometriosis N (%) Endometriosis N (%) Χ 2 p p-value Bonferroni correction (α=0,05) Vc Education Basic 239 (0.78) 8 (0.28) 51.58 <0.0001 Sig. 0.04 Secondary 9134 (28.9) 719 (25.1) Higher 21058 (68.9) 2127 (74.3) Studying 125 (0.4) 6 (0.2) Marital status Married 18529 (60.6) 1953 (68.2) 112.19 <0.0001 Sig. 0.06 Partnership 8778 (28.7) 645 (22.5) Single 2731 (8.9) 176 (6.2) Divorced/ separated 467 (1.5) 82 (2.9) Widow 56 (0.2) 6 (0.2) Nicotine dependence Actual or in the past 1077 (37.6%) 11150 (36.5%) 1.48 0.2233 - 0.01 Never 1785 (62.4%) 19411 (63.5%) BMI status Underweight. BMI<18.5 [kg/m2] 1555 (5.1) 185 (6.5) 35.11 <0.0001 Sig. 0.03 Normal. BMI 18.5-24.9 [kg/m2] 17560 (57.5) 1745 (61.0) Overweight BMI 25-29.9 [kg/m2] 7086 (23.2) 606 (21.2) Obesity BMI ≥ 30 [kg/m2] 4359 (14.3) 326 (11.4) Comorbidities Yes 6473 (21.2) 696 (24.3) 15.30 <0.0001 Sig. 0.02 No 24088 (78.8) 2166 (75.7) Any gestation in the past Yes 18158 (59.4) 1748 (61.1) 3.00 0.0835 - 0.01 No 12403 (40.6) 1114 (38.9) Sig. - statistically significant; NS - not statistically significant A higher incidence of comorbidities was observed in the group of women with endometriosis compared to healthy controls (1.13 vs 1.09, p = 0.002, η² < 0.01), but after applying the Bonferroni correction, the result was not significant, and the effect size was close to zero. Our study did not show any relationship between endometriosis and parity. 61.1% of women suffering from endometriosis had been pregnant before. 29.9% of these reported having at least one miscarriage in the past compared to 27.9% among those women without confirmed endometriosis ( p = 0.143). Among the endometriotic women the incidence of recurrent miscarriage, ectopic pregnancy, and caesarean section were significantly higher than among the analyzed controls (3.1% vs 1.9% p < 0.001, 4.1% vs 2.4%, p < 0.001; 53.7% vs 40.5%. p < 0.001 respectively). The estimated fertility rate in the studied group was 0.9. Women suffering from endometriosis seem to be more often burdened with other comorbidities. A higher proportion of patients with endometriosis had diagnoses of hypothyroidism (16.8 vs 14.9%), asthma (2.7 vs 2.1%), depression (0.8 vs 0.6%), hypertension (2.7 vs 1.5%), or psoriasis (1.2 vs 0.8%) (Table 7). Table 7. Comparison of comorbidities within studied groups Comorbidity Endometriosis N (%) Without endometriosis N (%) p-value Bonferroni correction (α=0,05) Hypothyroidism 487 (16.8) 4607 (14.9) 0.007 NS Asthma 79 (2.7) 658 (2.1) 0.030 NS Depression 26 (0.8) 166 (0.5) 0.040 NS Neoplasm 8 (0.3) 95 (0.3) 0.77 - Ulcerative colitis 6 (0.2) 80 (0.3) 0.59 - Hypertension 79 (2.7) 466 (1.5) <0.0010 Sig. Diabetes mellitus 24 (0.8) 206 (0.7) 0.31 - PCOS 51 (1.8) 615 (2.0) 0.39 - Psoriasis 35 (1.2) 239 (0.8) 0.01 NS Sig. - significant; NS - not Significant Endometriotic patients suffered more often from any kind of pelvic pain, Dysmenorrhea, or heavy menstrual bleeding. Detailed results are presented in Table 8. Table 8. The incidence of dysmenorrhea and pelvic pain among patients suffering from endometriosis Reported symptoms Confirmed endometriosis N (%) Without confirmed endometriosis N (%) Χ 2 p p-value Bonferroni correction (α=0,05) ϕ C Dysmenorrhea 2405 (84.0) 19906 (65.1) 421.0657 <0.0001 Sig. 0.11 Dyspareunia 1516 (52.9) 7792 (25.5) 983.0235 <0.0001 Sig. 0.17 Chronic pelvic pain 1768 (61.8) 7774 (25.4) 1693.935 <0.0001 Sig. 0.23 Painful defecation 1066 (37.3) 5641 (18.5) 575.9275 <0.0001 Sig. 0.13 Painful micturition 410 (14.3) 2417 (7.9) 139.17 <0.0001 Sig. 0.06 Bloody stools 379 (13.2) 2969 (9.7) 36.12630 <0.0001 Sig. 0.03 Blood in the urine 98 (3.4) 759 (2.5) 9.27 0.0023 NS 0.02 Heavy menstrual bleeding 1920 (67.1) 13812 (45.2) 503.36 <0.0001 Sig. 0.12 Sig. - significant; NS - not Significant From all the analyzed symptoms, the incidence of age at the onset of dysmenorrhea (15.6 vs 14.8. p = 0.0001), painful micturition (23.9 vs 21.3. p < 0.0001) differed between the studied groups. However, in relation to the age of the patients, only heavy menstrual bleeding occurred at an earlier age in endometriotic patients than in those without confirmed endometriosis. For all remaining symptoms there were no statistically significant differences in the age of the onset of complaints. Only 52% of women in the general population suffering from any kind of symptoms related to pelvic pain report these complaints to the gynecologist. Endometriotic patients report painful symptoms to their gynecologist almost twice as often as unaffected controls suffering from any kind of pelvic pain (88.9% vs 48.7%. p < 0.0001). Moreover, the severity of all analyzed complaints was significantly higher than among the patients without previous confirmation of endometriosis. Detailed data are presented in Table 9. Table 9. The severity of particular symptoms in the studied groups (NRS scale) Symptom Endometriosis M SD Min Max Q 25 Me Q 75 Z adjusted p-value Bonferroni correction (α=0,05) η2 Dysmenorrhea No 5.73 2.43 0.0 10.0 4.00 6.00 7.00 -15.81 <0.0010 Sig. 0.01 Yes 6.49 2.58 0.0 10.0 5.00 7.00 8.00 ∑ 5.81 2.46 0.0 10.0 4.00 6.00 8.00 Dyspareunia No 4.46 2.44 0 10.0 3.00 4.00 6.00 -9.91 <0.0010 Sig. 0.03 Yes 5.14 2.57 0 10.0 3.00 5.00 7.00 ∑ 4.57 2.47 0 10.0 3.00 5.00 6.00 Chronic pelvic pain No 4.63 2.30 0 10.0 3.00 5.00 6.00 -12.68 <0.0010 Sig. 0.02 Yes 5.44 2.58 0 10.0 4.00 5.00 7.00 ∑ 4.78 2.38 0 10.0 3.00 5.00 6.00 Painful defecation No 4.53 2.51 0 10.0 3.00 4.00 6.00 -6.54 <0.0010 Sig. 0.01 Yes 5.11 2.74 0 10.0 3.00 5.00 7.00 ∑ 4.62 2.55 0 10.0 3.00 5.00 6.00 Painful micturition No 3.51 2.76 0 10.0 1.00 3.00 5.00 -6.52 <0.0010 Sig. 0.02 Yes 4.51 2.88 0 10.0 2.00 4.00 7.00 ∑ 3.65 2.80 0 10.0 1.00 3,00 6.00 M – arithmetic mean, Me – median, N – number of samples, Q25, Me, Q75 – quartiles, SD – standard deviation, Sig. - significant; NS - not Significant The most frequently used contraceptive methods in the group of patients diagnosed with endometriosis were combined oral contraceptives (59.2%), progesterone-only pills (31.2%), and intrauterine devices (16.7%). Women suffering from endometriosis were found to use all types of hormonal contraceptive methods more often than women in general population (Table 10.). Table 10. Use of contraceptive methods by groups Contraceptive method Confirmed endometriosis N (%) Without confirmed endometriosis N (%) Χ 2 p p-value Bonferroni correction (α=0,05) ϕ C Combined oral contraceptives 617 (21.6) 4936 (16.2) 55.23 <0.0001 Sig. 0.04 Progesterone-only pills 325 (11.4) 2054 (6.7) 85.03 <0.0001 Sig. 0.05 Intrauterine device 174 (6.1) 1401 (4.6) 13.03 0.0003 Sig. 0.02 Subcutaneous progesterone implant 30 (1.1) 147 (0.5) 15.98 0.0001 Sig. 0.02 Intramuscular injections of progesterone 25 (0.9) 83 (0.3) 29.44 <0.0001 Sig. 0.03 Sig. - significant; NS - not Significant Endometriotic patients used analgesic drugs during menstruation to treat any kind of pelvic pain more often than undiagnosed controls (77.7% vs 63.2%; p < 0.0001, Χ 2 p = 238.7, ϕc = 0.08). After excluding women without dysmenorrhea (N = 22311, 2405 with endometriosis and 19906 controls) from further analysis, the remaining patients suffering from endometriosis were found to use painkillers during menstruation more often than other women (85.9 vs 82.3%). Moreover, women diagnosed with endometriosis used prescription drugs and drug combinations more often than monotherapy (20.4 vs 8.8%, and 65.7% vs 58.5%, respectively). Table 11. presents women’s preferences regarding usage of analgesic drugs and spasmolytics due to dysmenorrhea within particular groups. Table 11. The use of analgesic and spasmolytic drugs during menstruation. Analgesic drugs Confirmed endometriosis N (%) Without confirmed endometriosis N (%) Χ 2 p p-value Bonferroni correction (α=0,05) ϕ C Paracetamol 949 (33.2) 8296 (27.2) 47.28533 <0.0001 Sig. 0.04 Ibuprofen 1647 (57.5) 14129 (46.2) 134.4396 <0.0001 Sig. 0.06 Ketoprofen 521 (18.2) 2915 (9.5) 213.0635 <0.0001 Sig. 0.08 Metamizole 320 (11.2) 2017 (6.6) 84.44896 <0.0001 Sig. 0.05 Drotaverine 999 (34.9) 7833 (25.6) 115.7900 <0.0001 Sig. 0.06 Nimesulide 255 (8.5) 1325 (4.3) 102.6747 <0.0001 Sig. 0.06 Diclofenac 56 (2.0) 123 (0.4) 118.6612 <0.0001 Sig. 0.06 Tramadol 38 (1.3) 58 (0.2) 118.3175 <0.0001 Sig. 0.06 Sig. - significant; NS - not Significant While 87.0% of the healthy controls reported satisfactory pain relief after taking painkillers, 27.7% of the women with endometriosis did not experience a satisfactory reduction in dysmenorrhea and pelvic pain. Discussion The purpose of this case controlled cross-sectional study was to investigate the epidemiology and management of dysmenorrhea, dyspareunia, and chronic pelvic pain as well as to establish the phenotypes characteristic of Polish women suffering from endometriosis. To the best of our knowledge, this study is the first to address these questions by analyzing data from such a large sample of the Polish population, namely 33,769 respondents. The study prepared by our team showed that the prevalence of endometriosis within the overall Polish population can be estimated at 8.7%. Previous studies that explored this issue indicated a possible 10-15% prevalence in the general population of women of reproductive age and 70% prevalence in women with chronic pelvic pain [13,14]. According to Parazzini et al., who investigated a group of asymptomatic patients undergoing surgery due to other selected gynecological conditions the indicated prevalence rates were higher, at 30-45% [15]. Many gynecologists still believe that laparoscopy followed by histopathological examination remains the only way to diagnose the disease. Recent recommendations of the European Society of Human Reproduction and Embryology (ESHRE) encourage clinicians to use such imaging techniques as ultrasound and magnetic resonance imaging (MRI) in the diagnostic work-up for endometriosis [7]. According to our findings the main methods for confirming endometriosis were invasive procedures (laparoscopy or laparotomy, 60.8%), while noninvasive ultrasound findings such as endometrial cysts, DIE lesions or adenomyosis remained less popular methods (53.2%, 21.7% and 16.4%, respectively). Current recommendations indicate that based on results, there is no evidence of any advantage in using diagnostic laparoscopy compared to empirical medical treatment in women suspected of endometriosis [7]. Moreover, it is uncertain whether laparoscopic surgery outweighs diagnostic only laparoscopy in reducing overall pain associated with minimal to severe endometriosis [16]. The diagnostic delay of endometriosis is still a serious problem. The mean age of Polish women at diagnosis of their endometriosis was 27.4 years old, while the mean age at the onset of dysmenorrhea, which an early indication of endometriosis, was 15.6 years. According to our findings the mean time elapsed between the first symptoms and final confirmation of the disease was 11.8 years. Globally, the literature indicates that the mean diagnostic delay for endometriosis ranges from 6 to 11 years [17,18] and the most recent data from Italy also seem to confirm this [19]. This delay may result from women believing that clearly evident symptoms are required before seeking a diagnosis that includes invasive operative procedures. All of the above indicate the need to increase the contribution of imaging techniques in the detection of endometriosis and the need for further investigations into the potential for minimally invasive biomarkers [20,21]. An accurate pelvic ultrasound scan, performed by an expert sonographer, can provide an early diagnosis by identifying small endometriotic lesions, and thus minimize the delay between the onset of symptoms and diagnosis [22]. It is important for our field to emphasize that delays in diagnosis shouldn't be women's fault, particularly when systemic obstacles exist. Awareness of the phenotypes specific to endometriosis will help clinicians to select those women at risk of developing endometriosis. Patients suffering from endometriosis were older than the unaffected controls (33.3 vs 31.6 years) and of lower BMI levels (24.0 vs 24.6). There was a weak inverse association between weight and BMI compared with that observed in previous studies [23,24]. A literature review by Vigano et al., that analyzed 11 studies, confirmed this dependency between BMI and endometriosis [25]. The possible explanation for this association include difficulty to diagnose endometriosis in overweight women, more irregular and anovulatory menstrual cycles, socio-economic status and the loss of appetite due to severe pain [26]. Our findings did not show any significant correlation between endometriosis and smoking. There are inconsistent findings regarding this issue in the literature [27]. Smoking is thought to decrease levels of endogenous estrogen levels that could decrease the risk of endometrial tissue development. We observed a higher incidence of any comorbidities in the study group than in the healthy controls. Hypothyroidism, asthma, hypertension, and psoriasis occurred significantly more often within women suffering from endometriosis compared to healthy controls. An American National Health Service study pointed that the risk of coronary heart disease was higher in a population with endometriosis confirmed by laparoscopy (relative risk 1.62; 95% CI 1.39-1.89) [28]. An association between endometriosis and increased risk of cardiovascular disease events has been pointed out by previous investigators, however the possible reasons for this dependency remain unclear [29]. Females who suffer from endometriosis could be exposed to chronic, untreated inflammation, oxidative stress, and unfavorable lipid profile years before diagnosis [30]. Although the incidence of depression in the study group was almost twice as high as in the group of women without confirmation of endometriosis, this indicator turned out to be at relatively lower levels than indicated in previous studies. Incidence of depressive disorders was estimated at 14.5 to 15.1% of affected individuals [12,31]. Recent metanalysis by Gambadauro et al., (24 studies, 99,614 women) proved increased levels of depression in this group of patients (standardized mean difference of 0.49) [32]. The significant discrepancies of these findings may result from the different approaches taken to identify depression in patients. Previous studies usually assessed the risk of depressive symptoms by using standard screening questionnaires, while we asked patients whether they had previously diagnosed depressive symptoms. The very low incidence of depression identified in our study may result from the underestimation of depressive symptoms in the general population. It seems that the experience of pain, but not endometriosis itself, is the factor associated with mental health difficulties and emotional distress [33]. Several previous investigators indicated the association between autoimmune diseases such as rheumatoid arthritis or psoriasis and endometriosis. Epidemiological data suggest a higher proportion of hypothyroidism, asthma, and allergies among affected compared to the general population [34]. Our findings confirm previous observations over smaller study groups. These support the thesis that immunological factors may be a driver of endometriosis although in our most recent study we were not able to find significant differences as to the levels of autoantibodies between patients and controls after excluding autoimmunological diseases [20]. Older women, of higher education level, and with lower BMI levels are at increased risk of developing endometriosis and require particular attention by healthcare providers. Moreover, affected women could be more vulnerable to any other comorbidities. Disruption of normal pelvic anatomy and ovarian functions as a consequence of endometriosis may lead to infertility [35]. On the other hand, delayed childbearing is an independent risk factor of both fertility impairments and endometriosis. Contrary to the common myth that endometriosis could be cured by pregnancy, our study did not show any significant dependency between the incidence of endometriosis and parity. It is difficult to explain the relationship between childbearing and endometriosis. There are several reports in the literature that show that it is not pregnancy alone rather than the delivery method which could decrease the symptoms related to endometriosis [36]. Although menstruation-free period is thought of as a protective effect of childbearing, it should be emphasized that the cervical dilation that occurs during labor and delivery, possibly decrease the likelihood of retrograde menstruation [36,37]. It is hypothesized that retrograde menstruation occurs to some extend in all women of reproductive age. However, a persistence of menstrual debris leading to endometriotic lesions only occurs in a few. Praetorius et al., provided evidence that both pelvic endometriosis and ovarian endometriomas share the same genetic makeup, suggesting a common origin from similar or identical oligoclones of intrauterine endometrial tissue [38]. Previous investigators have observed a higher coexistence of autoimmune diseases among women with endometriosis than among other women. Dysfunction in the immune system response leading to the persistence of ectopic endometrial tissue could be a possible explanation of this observed correlation. Endometriosis is a systemic and chronic inflammatory disease whose dominant symptoms are pelvic pain and fertility impairments. All the analyzed symptoms, dysmenorrhea, dyspareunia, chronic pelvic pain, painful defecation, painful micturition, bloody stools, blood in the urine, and heavy menstrual bleeding, occurred almost twice as often in the study group compared with the group of women without previous diagnosis of endometriosis. In addition, the severity of any reported symptoms was significantly higher in the study group than among unaffected patients. Endometriotic patients report painful symptoms to the gynecologist almost twice as often as unaffected controls suffering from any kind of pelvic pain (88.9% vs 48.7%. p < 0.0001). It is worth emphasizing it still occurs that too many women hide the symptoms of pelvic pain and experience both physical and psychological burdens in relation to menstruation. Therefore, the role of gynecologists in the active analysis of symptoms and in enhancing patient education cannot be overestimated. Surprisingly, dysmenorrhea, dyspareunia, chronic pelvic, and painful defecation, which are the most commonly reported symptoms related to endometriosis, first occur significantly later after menarche than in patients without confirmed endometriosis. This confirms previous observations that secondary cases of dysmenorrhea, attributable to pelvic pathology, occurs later than primary cases, most often at least 12 months after menarche [39,40]. Preclinical studies suggest that the main causes of primary dysmenorrhea are prostaglandin-dependent mechanisms [41]. Genetic analyses published by Rahmioglu et al., identified significant correlations between endometriosis and other pain conditions such as migraine and multisite chronic pain [42]. Endometriotic patients used analgesics more often during menstruation due to any kind of pelvic pain compared to undiagnosed controls (77.7% vs 63.2%). Moreover, women diagnosed with endometriosis definitely used prescription analgesics (20.4 vs 8.8%) and drug combinations (65.7% vs 58.5%) more often than monotherapy. After excluding women without dysmenorrhea from further analysis, patients suffering from endometriosis still used painkillers during menstruation (85.9 vs 82.3%) more often than undiagnosed controls. While 87.0% of healthy controls reported satisfactory pain relief after taking painkillers, in the group of women with endometriosis 27.7% did not experience a satisfactory reduction in dysmenorrhea and pelvic pain. Non-steroidal anti-inflammatory drugs (NSAIDS) remain the main group of over-the-counter analgesics. According to Folabomi et al., about 18% of women with dysmenorrhea are unresponsive to these medications [43]. The failure of NSAIDS to relieve pain suggests multiple contributing pathological mechanisms. Anatomical alterations and pelvic adhesions that could be a result of endometriotic lesions may explain more severe symptoms and NSAID resistance. A clinical study performed by Stavroulis et al., found that 35% of women with NSAID-resistant dysmenorrhea had a diagnosis of endometriosis [44]. In these specific cases, clinicians should broaden the scope of the differential diagnosis, while also considering additional hormonal therapy as part of the treatment. Moreover Plouffe et al. showed that 13% of patients with pelvic pain and premenstrual syndrome had pure psychiatric etiologies for their symptoms [45]. Knowledge of such dependencies is essential to optimize appropriate management of menstrual pain in women diagnosed with endometriosis. Patients suffering from endometriosis more often use hormonal contraception methods than women in the general population. In our opinion, this is an optimistic trend, indicating an awareness among gynecologists of the effectiveness of hormonal treatment. Given that more than a quarter of patients do not experience a satisfactory pain reduction in dysmenorrhea and pelvic pain with simple analgesics, hormonal treatment should be offered as early as possible. However, the same advice does not apply to patients trying to conceive [7]. There are two major methodological issues related to our paper that could influence the reliability of our results. Because it is a case-control study evaluating the epidemiology of endometriosis that used an internet survey to ensure a large sample, this will have enhanced the reliability of the results obtained. We believe that such a large study population and data sample would be far more difficult to achieve if the study relied on in-person interviews or medical records. Cross-sectional studies are widely used to assess public health issues and provide a more reliable insight into the current epidemiological situation regarding a specific issue. It is important to point potential gaps between statistical significance and clinical significance, characteristic for large observational studies as e.g. multiple testing or confounding effect. Even small differences between groups may be deemed statistically significant due to the large sample size; however, these differences may have minimal clinical significance and might not significantly impact clinical practice. To reduce these risks, we introduced additional statistical tests, such as the Bonferroni correction for multiple comparisons. To eliminate the possibility of bias related to patients with suspicion of disease only, the study group excluded those, and only included patients with endometriosis confirmed objectively during laparoscopy or ultrasound. We did not assess the endometriosis stages due to assumed difficulties in interpreting data provided by patients. A potential limitation of our results is that the real percentage of endometriosis in the overall population could be higher than our data indicates due to the asymptomatic course of the disease. Some women could be underdiagnosed due to the lack or inappropriate diagnostic workup in the past. Therefore, we rather prefer the term “women without confirmed endometriosis”’ for our control group rather than assume they are truly healthy. However, from a public health point of view, we are interested in disease that produces any symptoms. Though the topic and data presented parallels other publications that are decades old, the fundamental relevance of the submission is that for all the modern advances in awareness and testing, medicine still has meaningful delays in diagnosing endometriosis despite clear symptoms. Conclusions Although endometriotic patients report painful symptoms to the gynecologist almost twice as often as unaffected women, the diagnostic delay is still unacceptably long at 11.8 years. Older women, of higher educational level and lower BMI who report severe symptoms of pelvic pain or dyspareunia together with abnormal uterine bleeding require particular attention. Considering patient safety and the need to shorten the diagnostic process there is a clear need to increase the role of imaging tests in the diagnosis of endometriosis. 27.7% of patients suffering from endometriosis experience a non-satisfactory reduction in dysmenorrhea and pelvic pain after taking painkillers. In this aspect, simultaneous treatment with other options such as hormonal therapy should be introduced as early as possible. Apart from endometriosis-associated symptoms that impact an individual’s quality of life, the economic burden associated with endometriosis is exacerbated by the associated higher incidence of chronic diseases such as depression, asthma, hypertension, and psoriasis. Declarations Ethics approval and consent to participate: The study was performed in accordance with the requirements of the Declaration of Helsinki for Medical Research involving Human Subject. Ethical approval was obtained from the Ethics Committee of the Medical University of Warsaw (Reference: AKBE/119/2018). Informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable Availability of data and materials: all of individual deidentified participant data as well as study protocol, statistical analysis plan and analytic code will be shared and available beginning 3 months and ending 5 years following article publication for anyone who wishes to access the data. Proposal should be directed to Corresponding Author. To gain access, data requestors will need to sign a data access agreement. Competing interests: all authors declare no conflict of interest Funding statement: nothing to declare, own sources Author’s contributions DW, DS, MW, NSW, PL, DW, DS conceived and drafted the original version of the article, DW, DS, NSW and PL participated in the conception of the article, DW, NSW and DS obtained and analyzed obtained data. DW, DS, MW, NSW, PL critically revised the article and approved the final graft. Acknowledgements: Not applicable References Lamvu, G.; Carrillo, J.; Ouyang, C.; Rapkin, A. 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Am J Obstet Gynecol 2019 , 220 , 230-241, doi:10.1016/j.ajog.2018.11.123. Culley, L.; Law, C.; Hudson, N.; Denny, E.; Mitchell, H.; Baumgarten, M.; Raine-Fenning, N. The social and psychological impact of endometriosis on women's lives: a critical narrative review. Hum Reprod Update 2013 , 19 , 625-639, doi:10.1093/humupd/dmt027. Sinaii, N.; Cleary, S.D.; Ballweg, M.L.; Nieman, L.K.; Stratton, P. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod 2002 , 17 , 2715-2724, doi:10.1093/humrep/17.10.2715. de Ziegler, D.; Borghese, B.; Chapron, C. Endometriosis and infertility: pathophysiology and management. Lancet 2010 , 376 , 730-738, doi:10.1016/S0140-6736(10)60490-4. Bulletti, C.; Montini, A.; Setti, P.L.; Palagiano, A.; Ubaldi, F.; Borini, A. Vaginal parturition decreases recurrence of endometriosis. Fertil Steril 2010 , 94 , 850-855, doi:10.1016/j.fertnstert.2009.04.012. Bulletti, C.; De Ziegler, D.; Polli, V.; Del Ferro, E.; Palini, S.; Flamigni, C. Characteristics of uterine contractility during menses in women with mild to moderate endometriosis. Fertil Steril 2002 , 77 , 1156-1161, doi:10.1016/s0015-0282(02)03087-x. Praetorius, T.H.; Leonova, A.; Lac, V.; Senz, J.; Tessier-Cloutier, B.; Nazeran, T.M.; Kobel, M.; Grube, M.; Kraemer, B.; Yong, P.J.; et al. Molecular analysis suggests oligoclonality and metastasis of endometriosis lesions across anatomically defined subtypes. Fertil Steril 2022 , 118 , 524-534, doi:10.1016/j.fertnstert.2022.05.030. Kho, K.A.; Shields, J.K. Diagnosis and Management of Primary Dysmenorrhea. JAMA 2020 , 323 , 268-269, doi:10.1001/jama.2019.16921. Stuparich, M.A.; Donnellan, N.M.; Sanfilippo, J.S. Endometriosis in the Adolescent Patient. Semin Reprod Med 2017 , 35 , 102-109, doi:10.1055/s-0036-1597121. Maia, H., Jr.; Maltez, A.; Studard, E.; Zausner, B.; Athayde, C.; Coutinho, E. Effect of the menstrual cycle and oral contraceptives on cyclooxygenase-2 expression in the endometrium. Gynecol Endocrinol 2005 , 21 , 57-61, doi:10.1080/09513590500099602. Rahmioglu, N.; Mortlock, S.; Ghiasi, M.; Moller, P.L.; Stefansdottir, L.; Galarneau, G.; Turman, C.; Danning, R.; Law, M.H.; Sapkota, Y.; et al. The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions. Nat Genet 2023 , 55 , 423-436, doi:10.1038/s41588-023-01323-z. Oladosu, F.A.; Tu, F.F.; Hellman, K.M. Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: epidemiology, causes, and treatment. Am J Obstet Gynecol 2018 , 218 , 390-400, doi:10.1016/j.ajog.2017.08.108. Stavroulis, A.I.; Saridogan, E.; Creighton, S.M.; Cutner, A.S. Laparoscopic treatment of endometriosis in teenagers. Eur J Obstet Gynecol Reprod Biol 2006 , 125 , 248-250, doi:10.1016/j.ejogrb.2005.08.024. Plouffe, L., Jr.; Stewart, K.; Craft, K.S.; Maddox, M.S.; Rausch, J.L. Diagnostic and treatment results from a southeastern academic center-based premenstrual syndrome clinic: the first year. Am J Obstet Gynecol 1993 , 169 , 295-303; discussion 303-297, doi:10.1016/0002-9378(93)90079-x. Additional Declarations No competing interests reported. Supplementary Files Supplementery.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3508411","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":247650072,"identity":"d783d010-cd6b-4e30-8741-6841252374b5","order_by":0,"name":"Damian Warzecha","email":"","orcid":"","institution":"Warsaw University","correspondingAuthor":false,"prefix":"","firstName":"Damian","middleName":"","lastName":"Warzecha","suffix":""},{"id":247650073,"identity":"1dfc73c9-66f3-4e94-bd64-669121109838","order_by":1,"name":"Daria Salloum","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDCCA2DEwMDHDiIrIIISQCxDUAsbM4g8g9DCg08LA1wLYxsRWviOn3144AdDnTwbM/MxqZvzDieubWA+eJuH4Q5OLZJn0g0O9jAcNmxjZkuTzt12OHHbAbZkax6GZzi1GBxIYzjAw3CAsY2Zxwyo5TZQC5DBw3AYt5bzzxgO/mGos4domQPSwv8Nv5YbaSBZ5kSIlgawLWx4tUjeeMZwWMbgcDLQL8nWOcf+G287zGZsOccAt1/4zqcxf3xTUWfbz9588HZOTZrstuPND2+8qbgjh0sL1HnIHGZIsODXgQ2QoWUUjIJRMAqGKwAAIdlUL5PzuC8AAAAASUVORK5CYII=","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":true,"prefix":"","firstName":"Daria","middleName":"","lastName":"Salloum","suffix":""},{"id":247650074,"identity":"d7098aff-6700-4756-b1a2-375f092cff1e","order_by":2,"name":"Mirosław Wielgoś","email":"","orcid":"","institution":"Lazarski University","correspondingAuthor":false,"prefix":"","firstName":"Mirosław","middleName":"","lastName":"Wielgoś","suffix":""},{"id":247650077,"identity":"c07647bc-10a1-4319-9b9e-29f2e06f6843","order_by":3,"name":"Nicole Sochacki-Wójcicka","email":"","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Nicole","middleName":"","lastName":"Sochacki-Wójcicka","suffix":""},{"id":247650080,"identity":"7b00d46c-4ccf-4d9d-b35f-2e49f46699c2","order_by":4,"name":"Piotr Laudański","email":"","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Piotr","middleName":"","lastName":"Laudański","suffix":""}],"badges":[],"createdAt":"2023-10-29 19:14:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3508411/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3508411/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":46378831,"identity":"08ca7ef6-2d66-44a8-b82d-fbd069353d2a","added_by":"auto","created_at":"2023-11-14 02:40:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41275,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHow endometriosis was diagnosed\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"F1.png","url":"https://assets-eu.researchsquare.com/files/rs-3508411/v1/66f1dd747715eeb44e5c61de.png"},{"id":81613433,"identity":"4300bf02-a108-41a3-a78c-1726b7961e30","added_by":"auto","created_at":"2025-04-29 07:47:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2347437,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3508411/v1/16d8c8cd-f911-4ede-bb02-e4030656f7e6.pdf"},{"id":46378832,"identity":"7801cb3d-5e18-41b1-9553-b00b9674ebf1","added_by":"auto","created_at":"2023-11-14 02:40:07","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":20838,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementery.docx","url":"https://assets-eu.researchsquare.com/files/rs-3508411/v1/ae2d6acf20a79fa4c65d9025.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiology, management and diagnostic workup for endometriosis related pelvic pain","fulltext":[{"header":"Background","content":"\u003cp\u003ePelvic pain is a debilitating gynecological condition that may affect up to 26% of women of childbearing age\u0026nbsp;[1]. It is believed that around 10% of gynecology appointments are related to this problem\u0026nbsp;[2]. Apart from strictly gynecological issues, urological, gastrointestinal and musculoskeletal factors are among the other most common causes\u0026nbsp;[3]. \u0026nbsp;There are several different types of pelvic pain e.g., chronic pelvic pain (CPP), dysmenorrhea, and dyspareunia. CPP by definition lasts for more than 6 months and causes a significant reduction in an individual\u0026rsquo;s quality of life and everyday functioning\u0026nbsp;[4]. Although, in most cases the underlying etiology remains unknown, endometriosis, pelvic inflammatory disease, tissue hypoxia, and pelvic floor muscle weakness are mentioned as the most common causes of this condition\u0026nbsp;[5].\u003c/p\u003e\n\u003cp\u003eEndometriosis is a complex disease with different clinical manifestations and variable symptomatic presentations. However, pain is often the first symptom. Endometriosis is defined as the presence of functional endometrial glands growing outside the uterus. Much of the existing epidemiological research on endometriosis has focused on characteristics of the menstrual cycle. Despite inconsistent findings, some previous research has indicated a higher risk of endometriosis with increasing exposure to menstruation. Moreover an early age at menarche, longer menstruation, and short menstrual cycles all contribute to an increased risk of endometriosis\u0026nbsp;[6]. The immunological, genetic, and serum markers proposed to date for the diagnosis of endometriosis are insufficiently sensitive and specific to justify their use as a screening test\u0026nbsp;[7]. The health burden of endometriosis related to chronic pain includes the considerable lifetime costs of $(US) 27,855 per patient\u0026nbsp;[8]. The annual healthcare expenditures for endometriosis are roughly $22 billion in the US and \u0026pound;12.2 billion in the UK, encompassing treatment, loss of employment, and medical services\u0026nbsp;[9].\u0026nbsp;Simoens et al., found that potential costs increase with the severity of endometriosis, the presence of pelvic pain, the presence of infertility, and the longer the duration after diagnosis\u0026nbsp;[10].\u003c/p\u003e\n\u003cp\u003eThe American Society for Reproductive Medicine (ASRM) classification system for endometriosis is based on the morphology, location, and size of peritoneal and pelvic implants\u0026nbsp;[11]. However clinical manifestation as well as the pain intensity seem to be independent of endometriosis stages\u0026nbsp;[12].\u003c/p\u003e\n\u003cp\u003eThe primary objective of the presented paper was to investigate the epidemiology, management and diagnostic workup of dysmenorrhea, dyspareunia, and chronic pelvic pain in a population of Polish women suffering from endometriosis. The secondary aim of the study was to establish the phenotypic pattern and incidence of other comorbidities in affected individuals.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA case controlled cross-sectional study was performed between April and May 2021.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAn electronic, anonymous questionnaire was prepared by the authors and shared by social media. The survey was developed for a Polish-speaking audience; however an English language version of the questionnaire was also prepared. The questionnaire asked for sociodemographic and medical information from the participants. The following sections concerned the duration, severity and treatment of symptoms related to pelvic pain and dysmenorrhea. Women were asked to identify the bases of the diagnosis of their endometriosis in accordance with the European Society of Human Reproduction and Embryology (ESHRE) guidelines, based on laparoscopic or ultrasound findings (adenomyosis, deep-infiltrating endometriosis, or ovarian endometrioma). Women with the suspicion of endometriosis, and who had neither surgical nor ultrasound confirmation, were not included in our further analysis of endometriotic patients. The study protocol included only pre-menopausal women, aged 16\u0026ndash;56 years. The original questionnaire is available as supplementary material.\u003c/p\u003e\n\u003cp\u003eThe study was performed in accordance with the requirements of the Declaration of Helsinki for Medical Research involving Human Subject. Ethical approval was obtained from the Ethics Committee of the Medical University of Warsaw (Reference: AKBE/119/2018).\u003c/p\u003e\n\u003cp\u003eThe significance of differences between the studied groups was tested with the Mann-Whitney U test for tied ranks, and the effect size was estimated using \u0026eta;2 (eta_square). For qualitative variables, numbers and their percentage share in subgroups were counted. The relationship between the occurrence of endometriosis and qualitative features was analyzed using the \u0026chi;2p test (Pearson\u0026apos;s chi-square), and the effect size using ϕC (Cramer\u0026apos;s phi) (2x2 tables) and VC (Cramer\u0026apos;s V). P-values below the 0.05 threshold were considered significant. In order to maintain the level of significance assumed for the entire study, a conservative Bonferroni correction was applied. Statistica 13.1 software (StatSoft Poland, Cracow, Poland) was used for statistical analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e33,769 respondents took part in the survey. The credibility of completed surveys was checked to exclude the possibility of bias arising from malicious bots. \u0026nbsp;346 records were excluded from further analysis due to incomplete or unreliable data. A further 370 surveys were withdrawn as the respondents were postmenopausal.\u003c/p\u003e\n\u003cp\u003eThe mean age of respondents was 31.8 years old (SD = 5.93). Most had a normal BMI level (18.5 \u0026ndash; 24.9, 57.8%, mean 24.5 [kg/m2], SD = 5.05), had a higher educational level (69.4%), and were married (61.3%). The baseline characteristics of the included women who completed the internet-based survey are presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Baseline characteristics of the study group\u003c/strong\u003e\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"264\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge [years]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eM\u0026plusmn;SD\u003c/p\u003e\n\u003cp\u003eMe (IQR)\u003c/p\u003e\n\u003cp\u003eMin-Max\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e31.8 \u0026plusmn; 5.93\u003c/p\u003e\n\u003cp\u003e31.0 (7.0)\u003c/p\u003e\n\u003cp\u003e16-56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"264\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI [kg/m\u003csup\u003e2\u003c/sup\u003e]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eM\u0026plusmn;SD\u003c/p\u003e\n\u003cp\u003eMe (IQR)\u003c/p\u003e\n\u003cp\u003eMin-Maks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e24.53\u0026plusmn;5.05\u003c/p\u003e\n\u003cp\u003e23.4 (6.2)\u003c/p\u003e\n\u003cp\u003e14.7 - 49.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"264\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducation level\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; N \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eBasic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e247\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e(0.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eSecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e9853\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e(29.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eHigher\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e23185\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e(69.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eStudying\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e(0.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e20482\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e(61.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003ePartnership\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e9423\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e(28.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e2907\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e(8.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eDivorced/separated\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e549\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e(1.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"169\"\u003e\n\u003cp\u003eWidow\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e(0.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eBMI \u0026ndash; Body Mass Index, M \u0026ndash; arithmetic mean, Me \u0026ndash; median, Min \u0026ndash; minimum, Max \u0026ndash; Maximum, N \u0026ndash; number of samples\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr /\u003e 76.7% of respondents did not suffer from any comorbidities. 23.3% reported at least one chronic disease. 2.2% two and 0.3% three or more. The most frequently indicated illnesses are presented in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Comorbidities in the study group\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"304\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003e% of answers\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003e% of cases\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003eHypothyroidism\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e5093\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e13.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e15.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003eAsthma\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e737\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e1.95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e2.17\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003ePCOS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e666\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e1.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e1.96\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e545\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e1.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e1.59\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003ePsoriasis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e274\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.80\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e230\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e192\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.57\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003eNeoplasm\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e103\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.30\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003eUlcerative colitis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e0.25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003ePCOS \u0026ndash; Polycystic Ovary Syndrome, N \u0026ndash; number of samples\u003cbr /\u003e \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e59.5% (19,906) of women who completed the survey had been pregnant previously. Of these, 28.0% reported having at least one miscarriage in the past. The incidence of recurrent miscarriages (3 or more consecutive pregnancy losses before the 22nd week of gestation) was 2.1%, and 2.5% had experienced at least one ectopic pregnancy. Among this group who had been pregnant previously, the fertility rate was 0.9. Vaginal delivery had been the most common form of delivery, however, 41% of the women had undergone at least one cesarean section. In general, the frequency of cesarean sections was 30.1% of all deliveries after the 22nd week of gestation.\u003c/p\u003e\n\u003cp\u003e27.6% of the total study group reported using some kind of hormonal contraceptive method. Among these, the most popular were combined oral contraceptives (61.6%), progesterone-only pills (26.4%), and levonorgestrel-releasing intrauterine devices (17.5%).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDysmenorrhea and pelvic pain\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTables 3 and 4 present the incidence of dysmenorrhea and pelvic pain in general population and age at the onset.\u003c/p\u003e\n\u003cp\u003eTable 3 The incidence of dysmenorrhea and pelvic pain in general population\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eSymptom\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003e% of participants\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"188\"\u003e\n\u003cp\u003e\u003cstrong\u003e% of participants with confirmed endometriosis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eDysmenorrhea\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e22311\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e31.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"188\"\u003e\n\u003cp\u003e81.27\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eDyspareunia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e9308\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e13.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"188\"\u003e\n\u003cp\u003e33.90\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eChronic pelvic pain\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e9542\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e13.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"188\"\u003e\n\u003cp\u003e34.76\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003ePainful defecation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e6707\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e9.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"188\"\u003e\n\u003cp\u003e24.43\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eBloody stools\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e3348\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e4.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"188\"\u003e\n\u003cp\u003e12.19\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003ePainful micturition\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e2827\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e4.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"188\"\u003e\n\u003cp\u003e10.30\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eBlood in the urine\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e857\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e1.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"188\"\u003e\n\u003cp\u003e3.12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eHeavy menstrual bleeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e15732\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e22.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"188\"\u003e\n\u003cp\u003e57.30\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eN \u0026ndash; number of samples\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 4. Age at the onset of dysmenorrhea or pelvic pain\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eAge at the onset of:\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eMin.\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eMax.\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eQ25\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eMe\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eQ75\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eDysmenorrhea\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e14.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e22275\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e4.269\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e9.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e51.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e12.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e13.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e16.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eDyspareunia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e23.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e6526\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e4.824\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e16.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e53.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e19.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e22.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e26.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eChronic pelvic pain\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e22.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e6138\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e6.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e8.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e39.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e17.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e21.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e26.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003ePainful defecation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e22.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e4309\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e6.010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e8.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e39.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e18.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e22.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e26.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eBloody stools\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e23.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e2406\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e5.459\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e8.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e39.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e20.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e24.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e28.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003ePainful micturition\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e21.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e1850\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e5.776\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e8.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e39.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e18.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e21.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e25.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eBlood in the urine\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e22.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e614\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e5.526\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e8.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e39.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e19.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e22.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e26.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eHeavy menstrual bleeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e16.72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e15730\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e6.380\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e10.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e43.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e12.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e14.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e19.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eM \u0026ndash;arithmetic mean, Me \u0026ndash; median, N \u0026ndash; number of samples, Q25, Me, Q75 \u0026ndash; quartiles, \u003cbr /\u003e SD \u0026ndash; standard deviation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eEndometriosis: epidemiology, symptoms, and treatment\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eIn 2,862 (8.7%) of the respondents, endometriosis was diagnosed by laparoscopy or ultrasound. The mean age at the diagnosis was 27.4 years old (SD = 5.75, Me = 25, Min = 13.0, Max = 52.0). Most cases were confirmed by laparoscopy or laparotomy (60.8%), while endometrial cysts were the most common findings during ultrasound scans (53.2% of cases). Detailed endometriosis diagnosis data are presented in Table 5 and Graph 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr /\u003e Table 5. How endometriosis was diagnosed\u003c/strong\u003e\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"284\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr /\u003e N\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr /\u003e % of participants\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u003cstrong\u003e% of participants \u003cbr /\u003e with confirmed \u003cbr /\u003e endometriosis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"284\"\u003e\n\u003cp\u003e\u003cstrong\u003ePeritoneal/DIE lesions of endometriosis on laparoscopy or laparotomy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e1522\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e34.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e60.86\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"284\"\u003e\n\u003cp\u003e\u003cstrong\u003eUltrasound \u0026ndash; endometrial cyst\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e1330\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e29.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e53.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"284\"\u003e\n\u003cp\u003e\u003cstrong\u003eUltrasound \u0026ndash; adenomyosis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e411\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e9.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e16.43\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"284\"\u003e\n\u003cp\u003e\u003cstrong\u003eUltrasound - DIE lesions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e543\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e12.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e21.71\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"284\"\u003e\n\u003cp\u003e\u003cstrong\u003eUltrasound \u0026ndash; pelvic adhesions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e664\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e14.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e26.55\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"284\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal sample\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e4470\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e100.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eDIE \u0026ndash; Deep Infiltrating Endometriosis, N \u0026ndash; number of samples,\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperative diagnosis of endometriosis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"213\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eBoth ways\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e617\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003elaparoscopy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e649\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003elaparotomy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e220\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eN/D\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026sum;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e1522\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"64\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eN/D - No Data \u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGraph 1. How endometriosis was diagnosed\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen suffering from endometriosis were significantly older than healthy participants, but the effect size was small (33.3, SD = 6.2 vs 31.6 y.o. SD = 5.9, Z=-13.99, p\u0026lt;0.0001, \u0026eta;\u003csup\u003e2\u003c/sup\u003e\u0026lt;0.01). Body Mass Index was statistically significantly lower among affected patients compared to controls (24.0, SD = 4.9 vs 24.6, SD = 5.0 kg/m\u003csup\u003e2\u003c/sup\u003e, Z=6.64, p\u0026lt;0.0001, \u0026eta;\u003csup\u003e2\u003c/sup\u003e=0.04). There was a statistically significant correlation between the occurrence of endometriosis and the woman\u0026rsquo;s education level, marital status, and BMI category. Table 6 Presents a comparison of baseline characteristics between patients with and without diagnosis of endometriosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Baseline characteristics of patients with and without endometriosis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"610\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"198\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e\u003cstrong\u003eWithout endometriosis\u003cbr /\u003e N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003eEndometriosis\u003cbr /\u003e N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Chi;\u003csup\u003e2\u003c/sup\u003ep\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003eBonferroni correction (\u0026alpha;=0,05)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"43\"\u003e\n\u003cp\u003e\u003cstrong\u003eVc\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eBasic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e239 (0.78)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e8 (0.28)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"51\"\u003e\n\u003cp\u003e51.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"57\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"78\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"43\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eSecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e9134 (28.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e719 (25.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eHigher\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e21058 (68.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e2127 (74.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eStudying\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e125 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e6 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e18529 (60.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e1953 (68.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" width=\"51\"\u003e\n\u003cp\u003e112.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" width=\"57\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" width=\"78\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" width=\"43\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003ePartnership\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e8778 (28.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e645 (22.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e2731 (8.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e176 (6.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eDivorced/ separated\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e467 (1.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e82 (2.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eWidow\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e56 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e6 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eNicotine dependence\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eActual or in the past\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e1077 (37.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e11150 (36.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"51\"\u003e\n\u003cp\u003e1.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"57\"\u003e\n\u003cp\u003e0.2233\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"78\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"43\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eNever\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e1785 (62.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e19411 (63.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eUnderweight.\u003cbr /\u003e BMI\u0026lt;18.5 [kg/m2]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e1555 (5.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e185 (6.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"51\"\u003e\n\u003cp\u003e35.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"57\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"78\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"43\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eNormal. BMI 18.5-24.9 [kg/m2]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e17560 (57.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e1745 (61.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eOverweight BMI 25-29.9 [kg/m2]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e7086 (23.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e606 (21.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eObesity BMI \u0026ge; 30 [kg/m2]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e4359 (14.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e326 (11.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e6473 (21.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e696 (24.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"51\"\u003e\n\u003cp\u003e15.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"57\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"78\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"43\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e24088 (78.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e2166 (75.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eAny gestation in the past\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e18158 (59.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e1748 (61.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"51\"\u003e\n\u003cp\u003e3.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"57\"\u003e\n\u003cp\u003e0.0835\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"78\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" width=\"43\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"89\"\u003e\n\u003cp\u003e12403 (40.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e1114 (38.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSig. - statistically significant; NS - not statistically significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA higher incidence of comorbidities was observed in the group of women with endometriosis compared to healthy controls (1.13 vs 1.09, p = 0.002, \u0026eta;\u0026sup2; \u0026lt; 0.01), but after applying the Bonferroni correction, the result was not significant, and the effect size was close to zero. Our study did not show any relationship between endometriosis and parity. 61.1% of women suffering from endometriosis had been pregnant before. 29.9% of these reported having at least one miscarriage in the past compared to 27.9% among those women without confirmed endometriosis (\u003cem\u003ep\u003c/em\u003e = 0.143). Among the endometriotic women the incidence of recurrent miscarriage, ectopic pregnancy, and caesarean section were significantly higher than among the analyzed controls (3.1% vs 1.9% \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, 4.1% vs 2.4%, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001; 53.7% vs 40.5%. p \u0026lt; 0.001 respectively). The estimated fertility rate in the studied group was 0.9.\u003c/p\u003e\n\u003cp\u003eWomen suffering from endometriosis seem to be more often burdened with other comorbidities. A higher proportion of patients with endometriosis had diagnoses of hypothyroidism (16.8 vs 14.9%), asthma (2.7 vs 2.1%), depression (0.8 vs 0.6%), hypertension (2.7 vs 1.5%), or psoriasis (1.2 vs 0.8%) (Table 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. Comparison of comorbidities within studied groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"625\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u003cstrong\u003eEndometriosis\u003cbr /\u003e N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eWithout endometriosis\u003cbr /\u003e N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eBonferroni correction (\u0026alpha;=0,05)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003eHypothyroidism\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e487 (16.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e4607 (14.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e0.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003eNS\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003eAsthma\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e79 (2.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e658 (2.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e0.030\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003eNS\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e26 (0.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e166 (0.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e0.040\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003eNS\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003eNeoplasm\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e8 (0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e95 (0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e0.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003eUlcerative colitis \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e6 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e80 (0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e0.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e79 (2.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e466 (1.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e\u0026lt;0.0010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e24 (0.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e206 (0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e0.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003ePCOS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e51 (1.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e615 (2.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e0.39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003ePsoriasis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e35 (1.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e239 (0.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003eNS\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSig. - significant; NS - not Significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEndometriotic patients suffered more often from any kind of pelvic pain, Dysmenorrhea, or heavy menstrual bleeding. Detailed results are presented in Table 8.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8. The incidence of dysmenorrhea and pelvic pain among patients suffering from endometriosis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u003cstrong\u003eReported symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e\u003cstrong\u003eConfirmed endometriosis\u003cbr /\u003e N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u003cstrong\u003eWithout confirmed endometriosis\u003cbr /\u003e N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Chi;\u003csup\u003e2\u003c/sup\u003ep\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"74\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cstrong\u003eBonferroni correction (\u0026alpha;=0,05)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e\u003cstrong\u003eϕ\u003csub\u003eC\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u003cstrong\u003eDysmenorrhea\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e2405 (84.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e19906 (65.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e421.0657\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"74\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u003cstrong\u003eDyspareunia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e1516 (52.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e7792 (25.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e983.0235\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"74\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.17\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u003cstrong\u003eChronic pelvic pain\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e1768 (61.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e7774 (25.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1693.935\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"74\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u003cstrong\u003ePainful defecation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e1066 (37.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e5641 (18.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e575.9275\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"74\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u003cstrong\u003ePainful micturition\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e410 (14.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e2417 (7.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e139.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"74\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u003cstrong\u003eBloody stools\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e379 (13.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e2969 (9.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e36.12630\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"74\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u003cstrong\u003eBlood in the urine\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e98 (3.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e759 (2.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e9.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"74\"\u003e\n\u003cp\u003e0.0023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eNS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u003cstrong\u003eHeavy menstrual bleeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"112\"\u003e\n\u003cp\u003e1920 (67.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e13812 (45.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e503.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"74\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSig. - significant; NS - not Significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFrom all the analyzed symptoms, the incidence of age at the onset of dysmenorrhea (15.6 vs 14.8. \u003cem\u003ep\u003c/em\u003e = 0.0001), painful micturition (23.9 vs 21.3. \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001) differed between the studied groups. However, in relation to the age of the patients, only heavy menstrual bleeding occurred at an earlier age in endometriotic patients than in those without confirmed endometriosis. For all remaining symptoms there were no statistically significant differences in the age of the onset of complaints. Only 52% of women in the general population suffering from any kind of symptoms related to pelvic pain report these complaints to the gynecologist. Endometriotic patients report painful symptoms to their gynecologist almost twice as often as unaffected controls suffering from any kind of pelvic pain (88.9% vs 48.7%. p \u0026lt; 0.0001). Moreover, the severity of all analyzed complaints was significantly higher than among the patients without previous confirmation of endometriosis. Detailed data are presented in Table 9.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9. The severity of particular symptoms in the studied groups (NRS scale)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"116%\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u003cstrong\u003eSymptom\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eEndometriosis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003eMin\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003eMax\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003eQ\u003csub\u003e25\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003eMe\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003eQ\u003csub\u003e75\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u003cstrong\u003eZ\u003csub\u003eadjusted\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003eBonferroni correction (\u0026alpha;=0,05)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026eta;2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"12%\"\u003e\n\u003cp\u003e\u003cstrong\u003eDysmenorrhea\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e6.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e7.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"8%\"\u003e\n\u003cp\u003e-15.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.0010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e6.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e7.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e8.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026sum;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e6.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e8.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"12%\"\u003e\n\u003cp\u003e\u003cstrong\u003eDyspareunia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e6.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"8%\"\u003e\n\u003cp\u003e-9.91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.0010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e7.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026sum;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e6.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"12%\"\u003e\n\u003cp\u003e\u003cstrong\u003eChronic pelvic pain\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e6.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"8%\"\u003e\n\u003cp\u003e-12.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.0010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e7.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026sum;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e6.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"12%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePainful defecation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e6.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"8%\"\u003e\n\u003cp\u003e-6.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.0010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e7.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026sum;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e6.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"12%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePainful micturition\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e5.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"8%\"\u003e\n\u003cp\u003e-6.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"9%\"\u003e\n\u003cp\u003e\u0026lt;0.0010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e2.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e4.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e7.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026sum;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e2.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e10.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e3,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e6.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"9%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eM \u0026ndash; \u003c/em\u003e\u003cem\u003earithmetic mean, Me \u0026ndash; median, N \u0026ndash; number of samples, Q25, Me, Q75 \u0026ndash; quartiles, \u003cbr /\u003e SD \u0026ndash; standard deviation, \u003c/em\u003e\u003cem\u003eSig. - significant; NS - not Significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe most frequently used contraceptive methods in the group of patients diagnosed with endometriosis were combined oral contraceptives (59.2%), progesterone-only pills (31.2%), and intrauterine devices (16.7%). Women suffering from endometriosis were found to use all types of hormonal contraceptive methods more often than women in general population (Table 10.).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 10. Use of contraceptive methods by groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eContraceptive method\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u003cstrong\u003eConfirmed endometriosis\u003cbr /\u003e N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u003cstrong\u003eWithout confirmed endometriosis\u003cbr /\u003e N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Chi;\u003csup\u003e2\u003c/sup\u003ep\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cstrong\u003eBonferroni correction (\u0026alpha;=0,05)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u003cstrong\u003eϕ\u003csub\u003eC\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eCombined oral contraceptives\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e617 (21.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e4936 (16.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e55.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eProgesterone-only pills\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e325 (11.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e2054 (6.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e85.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eIntrauterine device\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e174 (6.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e1401 (4.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e13.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.0003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eSubcutaneous progesterone implant\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e30 (1.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e147 (0.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e15.98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eIntramuscular injections of progesterone\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e25 (0.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e83 (0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e29.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSig. - significant; NS - not Significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEndometriotic patients used analgesic drugs during menstruation to treat any kind of pelvic pain more often than undiagnosed controls (77.7% vs 63.2%; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001, \u0026Chi;\u003csup\u003e2\u003c/sup\u003ep = 238.7, ϕc = 0.08). After excluding women without dysmenorrhea (N = 22311, 2405 with endometriosis and 19906 controls) from further analysis, the remaining patients suffering from endometriosis were found to use painkillers during menstruation more often than other women (85.9 vs 82.3%). Moreover, women diagnosed with endometriosis used prescription drugs and drug combinations more often than monotherapy (20.4 vs 8.8%, and 65.7% vs 58.5%, respectively). Table 11. presents women\u0026rsquo;s preferences regarding usage of analgesic drugs and spasmolytics due to dysmenorrhea within particular groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 11. The use of analgesic and spasmolytic drugs during menstruation.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"101\"\u003e\n\u003cp\u003e\u003cstrong\u003eAnalgesic drugs\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u003cstrong\u003eConfirmed endometriosis\u003cbr /\u003e N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u003cstrong\u003eWithout confirmed endometriosis\u003cbr /\u003e N (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Chi;\u003csup\u003e2\u003c/sup\u003ep\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cstrong\u003eBonferroni correction (\u0026alpha;=0,05)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u003cstrong\u003eϕ\u003csub\u003eC\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"101\"\u003e\n\u003cp\u003e\u003cstrong\u003eParacetamol\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e949 (33.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e8296 (27.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e47.28533\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"101\"\u003e\n\u003cp\u003e\u003cstrong\u003eIbuprofen\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e1647 (57.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e14129 (46.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e134.4396\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"101\"\u003e\n\u003cp\u003e\u003cstrong\u003eKetoprofen\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e521 (18.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e2915 (9.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e213.0635\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"101\"\u003e\n\u003cp\u003e\u003cstrong\u003eMetamizole\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e320 (11.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e2017 (6.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e84.44896\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"101\"\u003e\n\u003cp\u003e\u003cstrong\u003eDrotaverine\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e999 (34.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e7833 (25.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e115.7900\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"101\"\u003e\n\u003cp\u003e\u003cstrong\u003eNimesulide\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e255 (8.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e1325 (4.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e102.6747\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"101\"\u003e\n\u003cp\u003e\u003cstrong\u003eDiclofenac\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e56 (2.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e123 (0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e118.6612\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"101\"\u003e\n\u003cp\u003e\u003cstrong\u003eTramadol\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e38 (1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e58 (0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e118.3175\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eSig.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSig. - significant; NS - not Significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhile 87.0% of the healthy controls reported satisfactory pain relief after taking painkillers, 27.7% of the women with endometriosis did not experience a satisfactory reduction in dysmenorrhea and pelvic pain.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this case controlled cross-sectional study was to investigate the epidemiology and management of dysmenorrhea, dyspareunia, and chronic pelvic pain as well as to establish the phenotypes characteristic of Polish women suffering from endometriosis. To the best of our knowledge, this study is the first to address these questions by analyzing data from such a large sample of the Polish population, namely 33,769 respondents. The study prepared by our team showed that the prevalence of endometriosis within the overall Polish population can be estimated at 8.7%. Previous studies that explored this issue indicated a possible 10-15% prevalence in the general population of women of reproductive age and 70% prevalence in women with chronic pelvic pain\u0026nbsp;[13,14]. According to Parazzini et al., who investigated a group of asymptomatic patients undergoing surgery due to other selected gynecological conditions the indicated prevalence rates were higher, at 30-45%\u0026nbsp;[15].\u003c/p\u003e\n\u003cp\u003eMany gynecologists still believe that laparoscopy followed by histopathological examination remains the only way to diagnose the disease. Recent recommendations of the European Society of Human Reproduction and Embryology (ESHRE) encourage clinicians to use such imaging techniques as ultrasound and magnetic resonance imaging (MRI) in the diagnostic work-up for endometriosis\u0026nbsp;[7]. According to our findings the main methods for confirming endometriosis were invasive procedures (laparoscopy or laparotomy, 60.8%), while noninvasive ultrasound findings such as endometrial cysts, DIE lesions or adenomyosis remained less popular methods (53.2%, 21.7% and 16.4%, respectively). Current recommendations indicate that based on results, there is no evidence of any advantage in using diagnostic laparoscopy compared to empirical medical treatment in women suspected of endometriosis\u0026nbsp;[7]. Moreover, it is uncertain whether laparoscopic surgery outweighs diagnostic only laparoscopy in reducing overall pain associated with minimal to severe endometriosis\u0026nbsp;[16]. The diagnostic delay of endometriosis is still a serious problem. The mean age of Polish women at diagnosis of their endometriosis was 27.4 years old, while the mean age at the onset of dysmenorrhea, which an early indication of endometriosis, was 15.6 years. According to our findings the mean time elapsed between the first symptoms and final confirmation of the disease was 11.8 years. Globally, the literature indicates that the mean diagnostic delay for endometriosis ranges from 6 to 11 years\u0026nbsp;[17,18]\u0026nbsp;and the most recent data from Italy also seem to confirm this\u0026nbsp;[19]. This delay may result from women believing that clearly evident symptoms are required before seeking a diagnosis that includes invasive operative procedures. All of the above indicate the need to increase the contribution of imaging techniques in the detection of endometriosis and the need for further investigations into the potential for minimally invasive biomarkers\u0026nbsp;[20,21]. An accurate pelvic ultrasound scan, performed by an expert sonographer, can provide an early diagnosis by identifying small endometriotic lesions, and thus minimize the delay between the onset of symptoms and diagnosis\u0026nbsp;[22]. It is important for our field to emphasize that delays in diagnosis shouldn\u0026apos;t be women\u0026apos;s fault, particularly when systemic obstacles exist. Awareness of the phenotypes specific to endometriosis will help clinicians to select those women at risk of developing endometriosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients suffering from endometriosis were older than the unaffected controls (33.3 vs 31.6 years) and of lower BMI levels (24.0 vs 24.6). There was a weak inverse association between weight and BMI compared with that observed in previous studies\u0026nbsp;[23,24]. A literature review by Vigano et al., that analyzed 11 studies, confirmed this dependency between BMI and endometriosis\u0026nbsp;[25]. The possible explanation for this association include difficulty to diagnose endometriosis in overweight women, more irregular and anovulatory menstrual cycles, socio-economic status and the loss of appetite due to severe pain\u0026nbsp;[26]. Our findings did not show any significant correlation between endometriosis and smoking. There are inconsistent findings regarding this issue in the literature\u0026nbsp;[27]. Smoking is thought to decrease levels of endogenous estrogen levels that could decrease the risk of endometrial tissue development.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe observed a higher incidence of any comorbidities in the study group than in the healthy controls.\u0026nbsp;Hypothyroidism, asthma, hypertension, and psoriasis\u0026nbsp;occurred significantly more often within women suffering from endometriosis\u0026nbsp;compared to healthy controls. An American National Health Service study pointed that the risk of coronary heart disease was higher in a population with endometriosis confirmed by laparoscopy (relative risk 1.62; 95% CI 1.39-1.89)\u0026nbsp;[28].\u0026nbsp;An association between endometriosis\u0026nbsp;and increased risk of cardiovascular disease events has been pointed out by previous investigators, however the possible reasons for this dependency remain unclear\u0026nbsp;[29].\u0026nbsp;Females who suffer from endometriosis could be exposed to chronic, untreated inflammation, oxidative stress, and unfavorable lipid profile years before diagnosis\u0026nbsp;[30].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough the incidence of depression in the study group was almost twice as high as in the group of women without confirmation of endometriosis, this indicator turned out to be at relatively lower levels than indicated in previous studies. Incidence of depressive disorders was estimated at 14.5 to 15.1% of affected individuals\u0026nbsp;[12,31]. Recent metanalysis by Gambadauro et al., (24 studies, 99,614 women) proved increased levels of depression in this group of patients (standardized mean difference of 0.49)\u0026nbsp;[32]. The significant discrepancies of these findings may result from the different approaches taken to identify depression in patients. Previous studies usually assessed the risk of depressive symptoms by using standard screening questionnaires, while we asked patients whether they had previously diagnosed depressive symptoms. The very low incidence of depression identified in our study may result from the underestimation of depressive symptoms in the general population. It seems that the experience of pain, but not endometriosis itself, is the factor associated with mental health difficulties and emotional distress\u0026nbsp;[33]. Several previous investigators indicated the association between autoimmune diseases such as rheumatoid arthritis or psoriasis and endometriosis. Epidemiological data suggest a higher proportion of hypothyroidism, asthma, and allergies among affected compared to the general population\u0026nbsp;[34]. Our findings confirm previous observations over smaller study groups. These support the thesis that immunological factors may be a driver of endometriosis although in our most recent study we were not able to find significant differences as to the levels of autoantibodies between patients and controls after excluding autoimmunological diseases\u0026nbsp;[20].\u003c/p\u003e\n\u003cp\u003eOlder women, of higher education level, and with lower BMI levels are at increased risk of developing endometriosis and require particular attention by healthcare providers. Moreover, affected women could be more vulnerable to any other comorbidities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDisruption of normal pelvic anatomy and ovarian functions as a consequence of endometriosis may lead to infertility\u0026nbsp;[35]. On the other hand, delayed childbearing is an independent risk factor of both fertility impairments and endometriosis. Contrary to the common myth that endometriosis could be cured by pregnancy, our study did not show any significant dependency between the incidence of endometriosis and parity. It is difficult to explain the relationship between childbearing and endometriosis. There are several reports in the literature that show that it is not pregnancy alone rather than the delivery method which could decrease the symptoms related to endometriosis\u0026nbsp;[36]. Although menstruation-free period is thought of as a protective effect of childbearing, it should be emphasized that the cervical dilation that occurs during labor and delivery, possibly decrease the likelihood of retrograde menstruation\u0026nbsp;[36,37].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt is hypothesized that retrograde menstruation occurs to some extend in all women of reproductive age. However, a persistence of menstrual debris leading to endometriotic lesions only occurs in a few. Praetorius et al., provided evidence that both pelvic endometriosis and ovarian endometriomas share the same genetic makeup, suggesting a common origin from similar or identical oligoclones of intrauterine endometrial tissue\u0026nbsp;[38]. Previous investigators have observed a higher coexistence of autoimmune diseases among women with endometriosis than among other women. Dysfunction in the immune system response leading to the persistence of ectopic endometrial tissue could be a possible explanation of this observed correlation. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEndometriosis is a systemic and chronic inflammatory disease whose dominant symptoms are pelvic pain and fertility impairments. All the analyzed symptoms, dysmenorrhea, dyspareunia, chronic pelvic pain, painful defecation, painful micturition, bloody stools, blood in the urine, and heavy menstrual bleeding, occurred almost twice as often in the study group compared with the group of women without previous diagnosis of endometriosis. In addition, the severity of any reported symptoms was significantly higher in the study group than among unaffected patients. Endometriotic patients report painful symptoms to the gynecologist almost twice as often as unaffected controls suffering from any kind of pelvic pain (88.9% vs 48.7%. p \u0026lt; 0.0001). It is worth emphasizing it still occurs that too many women hide the symptoms of pelvic pain and experience both physical and psychological burdens in relation to menstruation. Therefore, the role of gynecologists in the active analysis of symptoms and in enhancing patient education cannot be overestimated. Surprisingly, dysmenorrhea, dyspareunia, chronic pelvic, and painful defecation, which are the most commonly reported symptoms related to endometriosis, first occur significantly later after menarche than in patients without confirmed endometriosis. This confirms previous observations that secondary cases of dysmenorrhea,\u0026nbsp;attributable to pelvic pathology, occurs later than primary cases, most often at least 12 months after menarche\u0026nbsp;[39,40]. Preclinical studies suggest that the main causes of primary dysmenorrhea are prostaglandin-dependent mechanisms\u0026nbsp;[41]. Genetic analyses published by Rahmioglu et al., identified significant correlations between endometriosis and other pain conditions such as migraine and multisite chronic pain\u0026nbsp;[42].\u003c/p\u003e\n\u003cp\u003eEndometriotic patients used analgesics more often during menstruation due to any kind of pelvic pain compared to undiagnosed controls (77.7% vs 63.2%). Moreover, women diagnosed with endometriosis definitely used prescription analgesics (20.4 vs 8.8%) and drug combinations (65.7% vs 58.5%) more often than monotherapy. After excluding women without dysmenorrhea from further analysis, patients suffering from endometriosis still used painkillers during menstruation (85.9 vs 82.3%) more often than undiagnosed controls. \u0026nbsp;While 87.0% of healthy controls reported satisfactory pain relief after taking painkillers, in the group of women with endometriosis 27.7% did not experience a satisfactory reduction in dysmenorrhea and pelvic pain. Non-steroidal anti-inflammatory drugs (NSAIDS) remain the main group of over-the-counter analgesics. According to Folabomi et al., about 18% of women with dysmenorrhea are unresponsive to these medications\u0026nbsp;[43]. The failure of NSAIDS to relieve pain suggests multiple contributing pathological mechanisms. Anatomical alterations and pelvic adhesions that could be a result of endometriotic lesions may explain more severe symptoms and NSAID resistance. A clinical study performed by Stavroulis et al., found that 35% of women with NSAID-resistant dysmenorrhea had a diagnosis of endometriosis\u0026nbsp;[44]. In these specific cases, clinicians should broaden the scope of the differential diagnosis, while also considering additional hormonal therapy as part of the treatment. Moreover Plouffe et al. showed that 13% of patients with pelvic pain and premenstrual syndrome had pure psychiatric etiologies for their symptoms\u0026nbsp;[45]. Knowledge of such dependencies is essential to optimize appropriate management of menstrual pain in women diagnosed with endometriosis.\u003c/p\u003e\n\u003cp\u003ePatients suffering from endometriosis more often use hormonal contraception methods than women in the general population. In our opinion, this is an optimistic trend, indicating an awareness among gynecologists of the effectiveness of hormonal treatment. Given that more than a quarter of patients do not experience a satisfactory pain reduction in dysmenorrhea and pelvic pain with simple analgesics, hormonal treatment should be offered as early as possible. However, the same advice does not apply to patients trying to conceive\u0026nbsp;[7].\u003c/p\u003e\n\u003cp\u003eThere are two major methodological issues related to our paper that could influence the reliability of our results. Because it is a case-control study evaluating the epidemiology of endometriosis that used an internet survey to ensure a large sample, this will have enhanced the reliability of the results obtained. We believe that such a large study population and data sample would be far more difficult to achieve if the study relied on in-person interviews or medical records. Cross-sectional studies are widely used to assess public health issues and provide a more reliable insight into the current epidemiological situation regarding a specific issue. It is important to point potential gaps between statistical significance and clinical significance, characteristic for large observational studies as e.g. multiple testing or confounding effect. Even small differences between groups may be deemed statistically significant due to the large sample size; however, these differences may have minimal clinical significance and might not significantly impact clinical practice. To reduce these risks, we introduced additional statistical tests, such as the Bonferroni correction for multiple comparisons.\u003c/p\u003e\n\u003cp\u003eTo eliminate the possibility of bias related to patients with suspicion of disease only, the study group excluded those, and only included patients with endometriosis confirmed objectively during laparoscopy or ultrasound. We did not assess the endometriosis stages due to assumed difficulties in interpreting data provided by patients. A potential limitation of our results is that the real percentage of endometriosis in the overall population could be higher than our data indicates due to the asymptomatic course of the disease. Some women could be underdiagnosed due to the lack or inappropriate diagnostic workup in the past. Therefore, we rather prefer the term \u0026ldquo;women without confirmed endometriosis\u0026rdquo;\u0026rsquo; for our control group rather than assume they are truly healthy. However, from a public health point of view, we are interested in disease that produces any symptoms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThough the topic and data presented parallels other publications that are decades old, the fundamental relevance of the submission is that for all the modern advances in awareness and testing, medicine still has meaningful delays in diagnosing endometriosis despite clear symptoms.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAlthough endometriotic patients report painful symptoms to the gynecologist almost twice as often as unaffected women, the diagnostic delay is still unacceptably long at 11.8 years. Older women, of higher educational level and lower BMI who report severe symptoms of pelvic pain or dyspareunia together with abnormal uterine bleeding require particular attention. Considering patient safety and the need to shorten the diagnostic process there is a clear need to increase the role of imaging tests in the diagnosis of endometriosis.\u003c/p\u003e\n\u003cp\u003e27.7% of patients suffering from endometriosis experience a non-satisfactory reduction in dysmenorrhea and pelvic pain after taking painkillers. In this aspect, simultaneous treatment with other options such as hormonal therapy should be introduced as early as possible. Apart from endometriosis-associated symptoms that impact an individual\u0026rsquo;s quality of life, the economic burden associated with endometriosis is exacerbated by the associated higher incidence of chronic diseases such as depression, asthma, hypertension, and psoriasis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate: \u0026nbsp;\u003c/strong\u003eThe study was performed in accordance with the requirements of the Declaration of Helsinki for Medical Research involving Human Subject. Ethical approval was obtained from the Ethics Committee of the Medical University of Warsaw (Reference: AKBE/119/2018). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eall of individual deidentified participant data as well as study protocol, statistical analysis plan and analytic code will be shared and available beginning 3 months and ending 5 years following article publication for anyone who wishes to access the data. Proposal should be directed to Corresponding Author. To gain access, data requestors will need to sign a data access agreement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e all authors declare no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u0026nbsp;\u003c/strong\u003enothing to declare, own sources\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDW, DS, MW, NSW, PL,\u003c/p\u003e\n\u003cp\u003eDW, DS conceived and drafted the original version of the article, DW, DS, NSW and PL participated in the conception of the article, DW, NSW and DS obtained and analyzed obtained data. DW, DS, MW, NSW, PL critically revised the article and approved the final graft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLamvu, G.; Carrillo, J.; Ouyang, C.; Rapkin, A. Chronic Pelvic Pain in Women: A Review. \u003cem\u003eJAMA \u003c/em\u003e\u003cstrong\u003e2021\u003c/strong\u003e, \u003cem\u003e325\u003c/em\u003e, 2381-2391, doi:10.1001/jama.2021.2631.\u003c/li\u003e\n\u003cli\u003eChandler, J.; Wagner, E.; Riley, K. Evaluation of Female Pelvic Pain. \u003cem\u003eSemin Reprod Med \u003c/em\u003e\u003cstrong\u003e2018\u003c/strong\u003e, \u003cem\u003e36\u003c/em\u003e, 99-106, doi:10.1055/s-0038-1676084.\u003c/li\u003e\n\u003cli\u003eGrinberg, K.; Sela, Y.; Nissanholtz-Gannot, R. 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Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: epidemiology, causes, and treatment. \u003cem\u003eAm J Obstet Gynecol \u003c/em\u003e\u003cstrong\u003e2018\u003c/strong\u003e, \u003cem\u003e218\u003c/em\u003e, 390-400, doi:10.1016/j.ajog.2017.08.108.\u003c/li\u003e\n\u003cli\u003eStavroulis, A.I.; Saridogan, E.; Creighton, S.M.; Cutner, A.S. Laparoscopic treatment of endometriosis in teenagers. \u003cem\u003eEur J Obstet Gynecol Reprod Biol \u003c/em\u003e\u003cstrong\u003e2006\u003c/strong\u003e, \u003cem\u003e125\u003c/em\u003e, 248-250, doi:10.1016/j.ejogrb.2005.08.024.\u003c/li\u003e\n\u003cli\u003ePlouffe, L., Jr.; Stewart, K.; Craft, K.S.; Maddox, M.S.; Rausch, J.L. Diagnostic and treatment results from a southeastern academic center-based premenstrual syndrome clinic: the first year. \u003cem\u003eAm J Obstet Gynecol \u003c/em\u003e\u003cstrong\u003e1993\u003c/strong\u003e, \u003cem\u003e169\u003c/em\u003e, 295-303; discussion 303-297, doi:10.1016/0002-9378(93)90079-x.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"endometriosis, dysmenorrhea, dyspareunia, pelvic pain","lastPublishedDoi":"10.21203/rs.3.rs-3508411/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3508411/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003e\u0026nbsp;It’s believed that around 10% of gynecology appointments are related to pelvic pain. Although in most cases the underlying etiology remains unknown, endometriosis is one of the most causes of this condition. The aim of our study was to investigate the epidemiology, diagnostic workup and management of dysmenorrhea, dyspareunia and chronic pelvic pain among women suffering from endometriosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: An electronic, anonymous questionnaire was prepared by the authors and shared by social media. Women were asked to identify the bases of the diagnosis of their endometriosis in accordance with the European Society of Human Reproduction and Embryology (ESHRE) guidelines. The study protocol included only pre-menopausal women, aged 16–56 years. 33,769 respondents took part in the survey. The credibility of completed surveys was checked to exclude the possibility of bias arising from malicious bots. The study group included 2,862 females with the diagnosis of endometriosis, according to the ESHRE guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The prevalence of endometriosis within the overall Polish population can be estimated at 8.7%. The mean time elapsed between the first symptoms and final confirmation of the disease was 11.8 years. The incidence and severity of all analyzed complaints was significantly higher that among the patients without previous confirmation of endometriosis (dysmenorrhea 84% vs 65.1%; dyspareunia 52.9% vs 25.5%; chronic pelvic pain 61.8% vs 25.4%) Patients suffering from endometriosis were older than the unaffected controls (33.3 vs 31.6 years, p \u0026lt;0.0001) and of lower BMI levels (24.0 vs 24.6, p = \u0026lt;0.0001) Endometriotic patients report painful symptoms to their gynecologist almost twice as often as unaffected controls suffering from any kind of pelvic pain (88.9% vs 48.7%. p \u0026lt; 0.0001). 27.7% of patients suffering from endometriosis experience a non-satisfactory reduction in dysmenorrhea and pelvic pain after painkillers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Although endometriotic patients report painful symptoms to the gynecologist almost twice as often as unaffected women, the diagnostic delay is still unacceptably long. Due to high rate of non-satisfactory reduction in dysmenorrhea and pelvic pain after taking painkillers simultaneous treatment with other options such as hormonal therapy should be introduced as early as possible.\u003c/p\u003e","manuscriptTitle":"Epidemiology, management and diagnostic workup for endometriosis related pelvic pain","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-14 02:40:02","doi":"10.21203/rs.3.rs-3508411/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a6b4dcd0-dadd-4feb-aaf4-4649b35399dc","owner":[],"postedDate":"November 14th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-29T07:38:56+00:00","versionOfRecord":[],"versionCreatedAt":"2023-11-14 02:40:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3508411","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3508411","identity":"rs-3508411","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}