Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain EDITORIAL COMMENT

Chronic pelvic pain is common in reproductive-aged women. A large number of women with chronic pelvic pain or endometriosis undergo hysterectomy: 10% to 32% for chronic pelvic pain and 5% to 19% for endometriosis. It is unknown how often endometriosis is identified during hysterectomy. Among reproductive-aged women, known risk factors for endometriosis include menorrhagia, dysmenorrhea, a family history of endometriosis, and decreased body mass index. Prior studies have examined potential risk factors associated with chronic pain and endometriosis in this population, but not specifically at the time of hysterectomy. Thus, it is unknown whether these risk factors correlate with the presence of endometriosis among women with chronic pelvic pain at the time of hysterectomy. The primary aimof this retrospective cohort study was to determine the prevalence of surgically confirmed endometriosis at the time of hysterectomy among women undergoing laparoscopic or abdominal hysterectomy (including those with and without a preoperative indication of chronic pelvic pain or endometriosis). A secondary aim was to examine risk factors associated with surgically confirmed endometriosis in women undergoing hysterectomy for chronic pelvic pain. Data were obtained from theMichigan Surgical Quality Collaborative, a statewide network of 52 hospitals, for 9622 women who underwent laparoscopic or abdominal hysterectomy for benign indications between January 1, 2013, and July 2, 2014. The prevalence of surgically confirmed endometriosis was estimated by review of surgical pathology reports and the operative report and was calculated for the entire cohort as well as subgroups of women with and without chronic pelvic pain or endometriosis. Multivariate logistic regression models were used to identify characteristics associated with endometriosis at the time of hysterectomy. A total of 9622 hysterectomies were available for analysis during the study period. Among these, 1465 (15.2%) had endometriosis at the time of hysterectomy. Of the 3768 women with a preoperative indication of chronic pelvic pain, less than 1 in 4 had endometriosis (21.4%, 806/3768). Many women with preoperative indication of endometriosis did not have endometriosis at the time of hysterectomy (42.8%, 527/1232). In women without a preoperative indication of chronic pelvic pain or endometriosis, the incidence of unexpected endometriosis was 8.0% (434/5457). Factors independently associated with endometriosis among women with a preoperative indication of chronic pelvic pain were younger age, a lower body mass index, white race, and previous failure of an alternative treatment. Among women with pelvic pain, oophorectomy was more commonly performed in those with surgically confirmed endometriosis than those without (47.4% vs 33.3%, P = 0.001). These findings show that less than 25% of women undergoing laparoscopic or abdominal hysterectomy for chronic pelvic pain have endometriosis at the time of surgery.