Ovarian endometrioma vascularization in women with pelvic pain

Objective: To assess whether a correlation exists between angiogenesis in ovarian endometrioma with the presence of pelvic pain. Design: Prospective study. Setting: Tertiary-care university hospital. Patient(s): Sixty-five patients (mean age, 33.3 years; range, 20-49 years) were diagnosed as having suspected cystic ovarian endometriosis, and were scheduled for surgery. Patients were classified into two groups according to clinical complaints: group A, asymptomatic patients or patients presenting mild dysmenorrhea; and group B, severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia. Intervention(s): Transvaginal power-Doppler ultrasonography and immunohistochemical staining for CD-34 in histological specimens. Main Outcome Measure(s): The amount of blood flow, lowest pulsatility and resistance indexes, and microvessel density (MVD). Result(s): Five patients were excluded after surgery because no ovarian endometriosis was found in histological analysis. Thirty women were included in each group. Ovarian endometriomas were more frequently vascularized in group B (87%) than in group A (60%). The lowest pulsatility and resistance indexes were significantly lower, and MVD was significantly higher, in group B compared with group A. There was a correlation between the degree of vascularization detected by power-Doppler ultrasound and MVD. Conclusion(s): We conclude that vascularization of ovarian endometriomas evaluated by transvaginal color Doppler and MVD is higher in patients who present with pelvic pain than in asymptomatic patients. This could be an indicator of the activity of endometriosis.