Early life factors for endometriosis

A systematic review

Endometriosis is an oestrogen-dependant chronic gynaecological
disorder where tissue that resembles endometrium (the lining of
the uterus) occurs outside of the uterus, typically in the pelvic area
(Zondervan et al., 2018). Indicators of the condition include chronic
pelvic pain, dysmenorrhea (painful menstruation with heavy bleeding),
dyspareunia (painful intercourse) and infertility (Missmer and Cramer,
2003; Zondervan et al., 2018). Endometriosis can also lead to
psychological, physical and social difficulties (Ferreira et al., 2016) and
carries a high economic burden from both direct and indirect health
costs (Simoens et al., 2007).
Reliable diagnosis of endometriosis currently requires surgical visualisation,
most commonly via laparoscopy. As a result, the prevalence
of the disease in the general population is difficult to quantify as it
can vary by diagnostic method and may be underestimated due to
undiagnosed disease. Based on estimates of pelvic pain and subfertility,
less than 2% of women of reproductive age have moderate or
severe endometriosis and the prevalence of the disease at all stages
is reported as 5–10% (Shafrir et al., 2018; Zondervan et al., 2018,
As-Sanie et al., 2019). Community based studies, however, report
a wider range of prevalence for diagnosed endometriosis, for
example from 4% of women in a large French cohort study (Farland
et al., 2017) to 11–11.5% for three studies of women in the
USA and Australia (Leibson et al., 2004; Buck Louis et al., 2011;
Australian Institute of Health and Welfare, 2019). The prevalence
of endometriosis is typically much higher for studies that recruit
women with gynaecological or reproductive problems, for example in
a Belgian study of women with infertility (with or without pelvic pain)
reporting that 47% were diagnosed with endometriosis via laparoscopy
(Meuleman et al., 2009). A recent systematic review of 15 studies of
adolescents found that overall 65% of girls undergoing laparoscopic
investigation were diagnosed with endometriosis, including 75% of
those with chronic pelvic pain resistant to treatment (Janssen et al.,

Karolína Olsarová and Gita D. Mishra



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