Imaging detection of Endometriosis in high-risk young women: The Endometriosis Awareness Promotion Project

• Based on demographic profile, menstrual pain and medication usage for menstrual pain, multivariable logistic regression analysis indicted that older age and women with low BMI were found to be possible high-risk factors for the imaging diagnosis of endometriosis. • A proper educational plan is needed among young women to understand the consequences of intractable cyclic pain and to identify high-risk individuals for early detection and timely management of menstrual pain and endometriosis. The presence of pelvic endometriosis is often confirmed by laparoscopic inspection in high-risk individuals. However, information on the detection of endometriosis by image is limited. The aim of this study was to investigate the imaging detection of endometriosis in high-risk young women belonging to the healthcare sector.. This is a single-center cross-sectional study using pen-and-paper questionnaires survey among medical and nursing students, which was conducted between 2018 and 2021 to assess the patterns of demographic profile, menstrual cycle, menstrual pain and the use of medication for menstrual pain. We performed multivariable logistic regression analysis with different confounding variables to identify high-risk factors in association with severe cyclic/acyclic pain and applied Firth’s bias-reduced logistic regression analysis for imaging detection of endometriosis. Among a total of 1011 young women, 462 female medical students and 549 female nursing students were recruited from a single center. Multivariable regression analysis revealed that risk of cyclic abdominal and pelvic pain severity was significantly low among nonusers of medication (hormonal or pain-killer) for both medical (P = 0.001 and P = 0.002, respectively) and nursing (P < 0.001 and P = 0.002, respectively) students. Among all participants, 352 were in the high-risk group (34.8% with a VAS score of ≥7). Forty of 352 students (11.4%) gave informed consent to take an ultrasonography examination (mostly rectal due to virginity concern). Twenty of 40 (50.0%) students were diagnosed with ovarian or deep endometriosis. Logistic regression analysis indicated that older age (OR = 2.70, 95% confidence interval (CI)=[1.22, 5.97], P = 0.014) and women with lower BMI (OR = 0.75, 95% CI=[0.55, 1.02], P = 0.07) were found to be high-risk factors for the imaging diagnosis of endometriosis. In this extended questionnaire-based observational study, we found that older age and women with lower BMI were associated with the risk of imaging diagnosis of endometriosis. A proper educational program may be necessary for young women and health-care providers to understand the consequence of intractable cyclic pain and to identify high-risk individuals in order to facilitate early detection and timely management of menstrual pain and endometriosis.