Endometriosis in Bangladesh: Epidemiological Insights from a Tertiary Hospital

Background: Endometriosis is a chronic, estrogen-dependent condition characterized by the presence of endometrial-like tissue outside the uterus. It is a significant cause of pelvic pain and infertility among women of reproductive age. While global prevalence estimates range from 10–15%, dedicated regional data in Bangladesh, particularly from Sylhet, remain scarce. Objective: To evaluate the prevalence, clinical presentation, and intraoperative staging of endometriosis among women undergoing diagnostic laparoscopy at a tertiary hospital in Sylhet, Bangladesh. Methods: A prospective observational study was conducted between January and June 2025 at North East Medical College & Hospital in Sylhet. One hundred women aged 18–45 years presenting with chronic pelvic pain or infertility were enrolled consecutively. Laparoscopic examination, performed by experienced gynecologists, confirmed endometriosis and enabled staging using the revised American Society for Reproductive Medicine (rASRM) system. Demographic data, symptom profiles, staging results, and lesion site details were collected. Statistical analysis included chi-square and Fisher’s exact tests, with significance set at p < 0.05. Results: Endometriosis was confirmed in 32% of participants (n=32). The mean age was 31.8 ± 4.9 years, and 64% were married. Common symptoms included pelvic pain (68.8%), dysmenorrhea (59.4%), infertility (53.1%), menorrhagia (25.0%), and dyspareunia (18.8%). A majority (59.4%) fell within moderate-to-severe rASRM stages (Stage II–III), with 21.9% classified as minimal (Stage I) and 18.8% as severe (Stage IV). The most frequent lesion sites were the pelvic peritoneum (53.1%), uterosacral ligaments (43.8%), and ovaries (37.5%). Significant associations were observed: advanced stages correlated with higher rates of pelvic pain (Stage III–IV: 90%; Stage I–II: 54.5%, p=0.03) and infertility (70% vs. 40%, p=0.04). Conclusions: Endometriosis is prevalent among symptomatic women undergoing laparoscopy in Sylhet, with moderate-to-severe disease frequently associated with pelvic pain and infertility. These findings underscore the need for early detection, prompt referral, and enhanced laparoscopic diagnostic capacity to improve patient outcomes.