VP05.04: Prevalence of endometriosis in premenopausal women attending general gynecology clinics

To determine the prevalence of endometriosis in premenopausal women attending general gynecology clinics. This was a prospective observational cohort study, conducted at a tertiary university hospital from February 2019 to October 2020. We included consecutive premenopausal women who had a transvaginal ultrasound scan performed by a single experienced examiner. Women with previous oophorectomy or hysterectomy were excluded. The presence, number and location of endometriotic cysts and lesions, and other pelvic pathology was noted, as well as demographic and clinical data. We included 1026 women in this study of which 194 (18.9%) had sonographic evidence of endometriosis. Of these 194 women, 88 (45.4%) had evidence of endometriomas, 169 (87%) had evidence of endometriotic nodules and 63 (32.5%) had both. 84 (64.1%) women had evidence of endometriotic nodules in the rectovaginal space, 59 (45.0%) in the uterosacral ligaments and 26 (19.9%) in the bowel. These were the most common locations for the presence of deep endometriosis. The indication for the examination was pelvic pain symptoms in 368 (35.9%) patients, whereas the remaining 658 (64.1%) patients had attended with non-pain related symptoms. 79 (7.8%) patients underwent laparoscopy by an experienced surgeon, of which 17 (21.5%) were diagnosed with endometriosis at surgery. There was agreement between the scan and surgery results in 76 out of 79 cases (96.2%). The calculated kappa value was 0.89 (95% CI: 0.66 to 1.00), suggesting excellent agreement between the two methods in the detection of the presence or absence of endometriosis. The prevalence of endometriosis in the general premenopausal population is higher than previously thought. Endometriosis can be diagnosed non-invasively with ultrasound in an outpatient setting and health care providers should allocate sufficient resources to facilitate a timely diagnosis. Specialised endometriosis services should be expanded to holistically manage symptomatic women.