|Year : 2020 | Volume
| Issue : 16 | Page : 65-68
Prevalence of endometriosis among women undergoing diagnostic laparoscopy at a tertiary hospital in North-Western Nigeria
Natalia Adamou1, Usman Aliyu Umar1, Faiza Lawan Mohammed2
1 Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Submission||25-Aug-2019|
|Date of Decision||27-Jan-2020|
|Date of Acceptance||21-May-2020|
|Date of Web Publication||26-Nov-2020|
Dr. Usman Aliyu Umar
Department of Obstetrics and Gynaecology, Bayero University and Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: Endometriosis is a complex gynecological disease in its physiopathological aspects and clinical implications. Signs and symptoms include pain and subfertility. The most common sites are pelvic organs and peritoneum. This study evaluated the prevalence of endometriosis among women undergoing diagnostic laparoscopy for chronic pelvic pain and infertility at a tertiary hospital in North-Western Nigeria over a 3-year period (from January 1, 2015, to December 31, 2017). Materials and Methods: A retrospective study of women who had diagnostic laparoscopy for chronic pelvic pain and infertility in our hospital was conducted. Theater operation register records and files of women who had laparoscopy for the same indications were retrieved and reviewed. Information on sociodemographic and reproductive characteristics as well as laparoscopic findings were extracted and reviewed. Results: The total number of women who had laparoscopy for the above indications over the study period was 92, of which 74 files were retrieved and analyzed. The prevalence of endometriosis was found to be 8.1%. Endometriosis was found to be more common in women whose complaint was chronic pelvic pain and/or dysmenorrhea. Conclusion: Endometriosis is a common, underreported gynecologic condition among women of reproductive age group presenting with infertility and chronic pelvic pain.
Keywords: Chronic pelvic pain, dysmenorrhea, endometriosis, infertility, laparoscopy
|How to cite this article:|
Adamou N, Umar UA, Mohammed FL. Prevalence of endometriosis among women undergoing diagnostic laparoscopy at a tertiary hospital in North-Western Nigeria. N Niger J Clin Res 2020;9:65-8
|How to cite this URL:|
Adamou N, Umar UA, Mohammed FL. Prevalence of endometriosis among women undergoing diagnostic laparoscopy at a tertiary hospital in North-Western Nigeria. N Niger J Clin Res [serial online] 2020 [cited 2021 Jan 19];9:65-8. Available from: https://www.mdcan-uath.org/text.asp?2020/9/16/65/301643
| Introduction|| |
Endometriosis is a disorder of women of reproductive age, characterized by the presence of endometrial glands and stroma outside the uterus. The most commonly affected sites are the pelvic organs and peritoneum, although other parts of the body such as the lungs are occasionally affected. It is a complex gynecological disease in its physiopathological aspects and clinical implications. Some women with endometriosis are asymptomatic, but for many, it has severe effects on their physical, mental, and social well-being. The clinical features include subfertility, severe dysmenorrhea, deep dyspareunia, and chronic pelvic pain. Symptoms arise from cyclical bleeding into the surrounding tissues, which results in inflammation and formation of scarring and adhesions. Lesions may be active or inactive and are present as white, red, clear, or bluish-black in pigment. Endometriosis is a progressive chronic disease, which affects patient quality of life, as a result of chronic pelvic pain, dyspareunia, infertility, long-term medical therapy, and risk of operative interventions, leading to anger, depression, marital disharmony, and reduction in social and leisure activity.
The true prevalence of endometriosis is not known, as diagnostic confirmation is accomplished only by inspection at the time of surgery (usually laparoscopy), and unknown numbers of women are either asymptomatic or do not seek treatment for their symptoms. The prevalence of endometriosis is estimated to be 8%–10% in women of reproductive age worldwide,, although high prevalence rates have been noted among women with chronic pelvic pain (>33%) and subfertility (30%–50%).
A study in a maternity hospital in Cairo reported a prevalence of up to 18.4%. In sub-Saharan Africa, epidemiological data on the prevalence of endometriosis among African indigenous women are meager. Ekwempe and Harrison first reported endometriosis among 27 Hausa-Fulani women of Northern Nigeria in 1979. In some other few published studies, endometriosis constituted the third most common finding at laparoscopies and was reported in 15.7% of laparoscopies performed for infertility assessment. In Nigeria, the prevalence as low as 4.9% and as high as 48.1% have been reported.
The etiology of endometriosis is complex, and the leading theories include retrograde menstruation with transport of endometrial cells, metaplasia of coelomic epithelium, hematogenous or lymphatic spread, and direct transplantation of endometrial cells. A combination of these theories is likely to be responsible.
The aim of this study was to determine the prevalence of endometriosis among women who underwent diagnostic laparoscopy for chronic pelvic pain and infertility at our tertiary health center.
The objectives were to describe the age and parity distribution of the patients diagnosed with endometriosis and to describe the common presenting symptoms and findings at laparoscopy.
| Materials and Methods|| |
This was a 3-year retrospective study of women who had diagnostic laparoscopy for chronic pelvic pain and infertility in Aminu Kano Teaching Hospital. Our center offers only diagnostic laparoscopy. Data were collected between January 1, 2015, and December 31, 2017. The operation register for laparoscopy was retrieved, and only women who had laparoscopy and dye test for infertility and chronic pelvic pain within the study period were included in the study. Patients with a prior history of pelvic surgery and pelvic inflammatory disease were excluded from the study. Laparoscopy was done during the secretory phase of the menstrual cycle. Our patients receive mainly medical therapy due to a lack of interventional laparoscopic treatment. These treatments are usually by the administration of gonadotropin-releasing hormone agonists, progestins, oral contraceptive pills, and androgens.
Folders were retrieved from the medical records, and information regarding the age, parity, religion, ethnicity, education, occupation, indications for the procedure, as well as intraoperative diagnosis were extracted using a predesigned pro forma.
Microsoft Excel 2013 was used for data entry, and analysis was done using SPSS version 21 (IBM Corp., Armonk, NY, USA). The results were displayed in frequency tables and percentage.
Approval for the study was granted by the Research and Ethics Committee of Aminu Kano Teaching Hospital.
| Results|| |
A total of 125 laparoscopies were done during the study period, of which 92 were done on account of infertility and chronic pelvic pain. For the stated indications, 74 files were retrieved and analyzed, giving a retrieval rate of 80.4%.
Majority (59, 79.7%) of the women were 35 years and below, 47 (63.5%) of them were nulliparous, with only 8 (10.8%) multiparous women. They were mostly Muslim (62, 83.8%), Hausa (55, 74.3%), and homemakers (47, 63.5%), with secondary school education (39, 52.7%). These data are shown in [Table 1].
Most of the women (33, 44.6%) had laparoscopy for primary infertility with only 5 (6.8%) having laparoscopy for chronic pelvic pain. Laparoscopic findings within the study period include 6 (8.1%) normal pelvic findings, 6 (8.1%) endometriotic lesions, 43 (58.1%) tubal factors, including hydrosalpinges and tubal blockage, and 19 (25.7%) other factors including uterine fibroids and frozen pelvis. Five (6.8%) of the patients with frozen pelvis also had distal tubal blockage. This information is displayed in [Table 2].
[Table 3] shows that endometriosis was found to be more common in women whose complaint was chronic pelvic pain and/or dysmenorrhea, 3 (4.69%) than those presenting without those symptoms, although it is important to evaluate a larger population of women to interpret the findings.
| Discussion|| |
Endometriosis is still an important problem in women of reproductive age and is underreported in the northern part of Nigeria. The results of the study showed that about 80% of the women were below 35 years, with a mean age of 30.7 (standard deviation [SD] ± 5.6) years. This finding is similar to that of 30.3 (SD ± 4.1) years reported in Nnewi and is also comparable to the finding of 33.2 (SD ± 6.3) years reported in Brazil.
Majority of the patients (63.5%) were nulliparous. Over 50% of them had at least secondary level of education. Despite that, majority of them were homemakers, 47 (63.5%). This could be explained by the cultural and religious beliefs in the northern part of Nigeria.
The prevalence of endometriosis in this study was 8.1% which was different from the prevalence reported in a retrospective study done in Nnewi (4.9%). Studies done in Ibadan, Egypt, and the US, however, reported much higher prevalence of 48.1%, 18.8%, and 38.9%, respectively. This disparity may be due to the fact that some studies were prospective studies and some were done in hospitals that provide laparoscopic surgeries and assisted reproduction, in which efforts were made to look out for endometriotic lesions at laparoscopy and proper documentation. In addition, video recordings of the procedure could have also prevented underreporting.
Pelvic adhesions with distorted pelvic anatomy (frozen pelvis) and tubal factors were other findings that were documented during laparoscopy in our patients (25.7% and 58.1%, respectively). These could also be due to severe endometriosis or due to other conditions such as chronic inflammatory disease. However, it is difficult to link this finding to endometriotic etiology only due to absence of intra-operative biopsy that can confirm the pathology. Additional limitation we encountered was an incomplete description of lesions that were found intraoperatively.
Although we found endometriosis to be more common in women whose complaint was chronic pelvic pain and/or dysmenorrhea, 3 (4.69%) than those presenting without those symptoms, this number is too small to allow for inferences. There is a need to evaluate a larger population of women to interpret similar findings. A high index of suspicion and additional training is required to recognize and document endometriotic lesions, size, extent, and characteristics during laparoscopic procedure in our center.
| Conclusion|| |
Endometriosis is a common, underreported gynecologic condition among women of reproductive age group presenting with infertility and chronic pelvic pain. A high index of suspicion at laparoscopy for such indications will go a long way in reducing the rate of underreporting.
- We could not review the psychosocial effect of endometriosis among our study group since it is a retrospective study. Most of such information were missing in the patients' folders
- Details of characteristics of endometriotic lesions were not documented in the operation notes, thereby limiting data analysis in terms of severity of the disease and types of lesions
- Interobserver differences in terms of identifying subtle lesions as endometriosis might have contributed to underreporting.
- A pro forma should be made and used for documenting laparoscopic findings with all the needed information for research purposes
- The management should upgrade the present laparoscopy machine to allow for video recordings for more objective assessment and better record keeping
- There is a need to perform a prospective study that will evaluate the gaps identified in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]