• Users Online: 128
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 16  |  Page : 65-68

Prevalence of endometriosis among women undergoing diagnostic laparoscopy at a tertiary hospital in North-Western Nigeria


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 Submission25-Aug-2019
Date of Decision27-Jan-2020
Date of Acceptance21-May-2020
Date of Web Publication26-Nov-2020

Correspondence Address:
Dr. Usman Aliyu Umar
Department of Obstetrics and Gynaecology, Bayero University and Aminu Kano Teaching Hospital, Kano
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nnjcr.nnjcr_43_19

Rights and Permissions
  Abstract 


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 24];9:65-8. Available from: https://www.mdcan-uath.org/text.asp?2020/9/16/65/301643




  Introduction Top


Endometriosis is a disorder of women of reproductive age, characterized by the presence of endometrial glands and stroma outside the uterus.[1] The most commonly affected sites are the pelvic organs and peritoneum, although other parts of the body such as the lungs are occasionally affected.[2] 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.[1] The clinical features include subfertility, severe dysmenorrhea, deep dyspareunia, and chronic pelvic pain.[2] 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.[3] 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.[2]

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.[4] The prevalence of endometriosis is estimated to be 8%–10% in women of reproductive age worldwide,[2],[5] although high prevalence rates have been noted among women with chronic pelvic pain (>33%) and subfertility (30%–50%).[6]

A study in a maternity hospital in Cairo reported a prevalence of up to 18.4%.[7] 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.[8] 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.[9] In Nigeria, the prevalence as low as 4.9%[10] and as high as 48.1%[11] 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.[12]

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 Top


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 Top


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].
Table 1: Sociodemographic and reproductive characteristics of patients

Click here to view


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 2: Indications for laparoscopy and laparoscopic findings

Click here to view


[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.
Table 3: Preoperative versus operative diagnosis

Click here to view



  Discussion Top


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[10] and is also comparable to the finding of 33.2 (SD ± 6.3) years reported in Brazil.[13]

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%,[11] 18.8%,[14] and 38.9%,[15] 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 Top


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.

Limitations

  1. 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
  2. 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
  3. Interobserver differences in terms of identifying subtle lesions as endometriosis might have contributed to underreporting.


Recommendations

  1. A pro forma should be made and used for documenting laparoscopic findings with all the needed information for research purposes
  2. The management should upgrade the present laparoscopy machine to allow for video recordings for more objective assessment and better record keeping
  3. There is a need to perform a prospective study that will evaluate the gaps identified in this study.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Prasannan-Nair C, Manias T, Mathur R. Management of endometriosis-related subfertility. Obstetr Gynaecol 2011;13:1-6.  Back to cited text no. 1
    
2.
Stephen K, Philippe K. Endometriosis. In: Edmond DK, editors. Dewhurst's Textbook of Obstetrics and Gynaecology. 8th ed. Chichester, West Sussex (UK): Blackwell Publishers; 2012. p. 615-24.  Back to cited text no. 2
    
3.
Stacey AM, Daniel WC. The epidemiology of endometriosis. Obstet Gynecol Clin N Am 2003;30:1-19.  Back to cited text no. 3
    
4.
Signorello LB, Harlow BL, Cramer DW, Spiegelman D, Hill JA. Epidemiologic determinants of endometriosis: A hospital-based case-control study. Ann Epidemiol 1997;7:267-741.  Back to cited text no. 4
    
5.
Wellbery C. Diagnosis and treatment of endometriosis. Am Fam Physician 1999;60:1753-62, 1767-8.  Back to cited text no. 5
    
6.
Guo SW, Wang Y. The prevalence of endometriosis in women with chronic pelvic pain. Gynecol Obstet Invest 2006;62:121-30.  Back to cited text no. 6
    
7.
Elsokkary M. The prevalence of typical and subtle lesions of endometriosis visiuaized in diagnostic laparoscopy for women with unexplained infertility. Int J Gynaecol Obstet Res 2016;3:391-9.  Back to cited text no. 7
    
8.
Ekwempe CC, Harrison KA. Endometriosis among the Hausa/Fulani population of Nigeria. Trop Geogr Med 1979;31:201-5.  Back to cited text no. 8
    
9.
Uche AM. Managing endometriosis in sub-Saharan Africa: Emerging concepts and new techniques. Afr J Reprod Health 2015;19:13-6.  Back to cited text no. 9
    
10.
Ikechebelu JI, Eleje GU, Okafor CD, Akintobi AO. Endometriosis seen at diagnostic laparoscopy for women with infertility. J Gynecol Res Obstet 2015;1:6-9.  Back to cited text no. 10
    
11.
Fawole AO, Bello FA, Ogunbode O, Odukogbe AT, Nkwocha GC, Nnoaham KE, et al. Endometriosis and associated symptoms among Nigerian women. Int J Gynaecol Obstet 2015;130:190-4.  Back to cited text no. 11
    
12.
Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Saridogan E, et al. ESHRE guideline on the diagnosis and management of endometriosis. Hum Reprod 2005;20:2698-704.  Back to cited text no. 12
    
13.
Sahu L, Tempe A. Laparoscopic management of endometriosis in infertile women and outcome. Int J Reprod Contracept Obstet Gynecol 2013;2:177-81.  Back to cited text no. 13
    
14.
Darwish AM, Hassanin MS, Abou Sekkin IA. Epidemiology and risk factors associated with laparoscopically diagnosed typical and atypical endometriosis among Egyptian women. Middle East Fertil Soc J 2006;11:196-201.  Back to cited text no. 14
    
15.
Wei JZ, Campeau J, Pearce CL, Randel KE, Templeman C. Prevalence of endometriosis in Hispanic women undergoing gynecologic laparoscopy at LAC + USC medical center. J Minim Invasive Gynecol 2012;19:S7-8.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed354    
    Printed14    
    Emailed0    
    PDF Downloaded4    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]