Prevalence of endometriosis in diagnostic and therapeutic laparoscopy among women with chronic pelvic pain

Abstract Background: When peritoneal endometriosis is clinically suspected, empirical medical therapy should be the first-line treatment. Diagnostic and therapeutic laparoscopy may be offered after failed or unsuitable medical therapy in women with severe pelvic pain and no imaging findings. Our objective was to determine how often endometriosis is verified among these women via laparoscopy. Methods: In our registry-based historical cohort we identified 296 women aged 15–49 undergoing laparoscopy due to chronic pelvic pain, between 2009 and 2020 at Turku University Hospital. Women without preoperative ultrasound findings and no history of endometriosis were included in the study. We collected preoperative characteristics and intraoperative findings from the hospital patient records. The prevalence of endometriosis in laparoscopy was the primary outcome. Results: Macroscopic endometriosis was detected in 52.4% of laparoscopies, and the rate was similar throughout the study period. Peritoneal endometriosis was found in 52% of participants, deep endometriosis in 4.7% and a small endometrioma in 2%. Women with and without endometriosis reported similar preoperative rates of acyclic abdominal pain (91.8% vs 93.9%, P=0.64) and dyspareunia (84.6% vs 78.9%, P =0.32), while dyschezia was significantly more common among women with endometriosis (44.4% vs 26.9%, P =0.006). The prevalence of dysmenorrhea is not reported, as 62.5% of patients used hormonal therapy commonly aiming to amenorrhea. The median age at the onset of symptoms was significantly lower in women with endometriosis (14 vs 19, P =0.048). Conclusions: Endometriosis was confirmed in 52.4% of the women undergoing laparoscopy due to chronic pelvic pain, and in most women, peritoneal endometriosis was the only finding. However, the other half of the women did not have endometriosis despite having similar pain symptoms. Two preoperative characteristics differed significantly between the groups; women with endometriosis had earlier onset of pain symptoms and they reported dyschezia more commonly. It remains unknown whether patients benefit long-term from undergoing diagnostic and therapeutic laparoscopy.