Abstract
Introduction: Endometriosis is a chronic disorder that negatively impacts patient’s quality of life. Following surgery to treat the disease, 20-60% of patients will experience symptom recurrence. This study aimed to identify risk factors associated with a first and recurrent diagnosis of endometriosis.
Methods: Clinical records and surveys were obtained with consent (n=716 participants). Data on phenotypes present prior to primary diagnosis (age at menarche, gravidity/parity, smoking and medical history [e.g. patient reported past diagnosis of endometriosis, adenomyosis, uterine fibroids]) and those present at the time of surgery (age, BMI, hormone status, stage of endometriosis) were extracted. Following laparoscopic visualisation, women were stratified into non-endometriosis (n=234), endometriosis ‘first-diagnosis’ (n=293) and endometriosis ‘recurrence’ (patient reported) (n=181) groups. Odds ratios (ORs) and 95% confidence intervals (CI) were calculated using multinomial logistic regression. Variables significant at p<0.1 were included in the adjusted multivariable model (AOR).
Results: In our overall cohort, n=234 (32.7%) women did not receive a diagnosis of endometriosis, while n=482 (67.3%) women did have surgically-visualised endometriosis. Compared to non-endometriosis patients, women with a first-diagnosis of endometriosis (n=293) were more likely to have lower BMI (AOR=0.9; 95% CI 0.9-1.0; p-trend <0.001), have fewer pregnancies (AOR=0.4; 0.3-0.5; p-trend <0.001), were less likely to report current hormone contraceptive use (AOR=0.5; 0.3-0.7; p <0.001), and were less likely to report a history of uterine fibroids (AOR=0.3; 0.2-0.7; p = 0.005). In contrast, compared to the non-endometriosis group, women with recurrent endometriosis were more likely to be older (AOR=1.0; 1.0-1.1; p-trend = 0.043) and have a history of adenomyosis (AOR=2.9; 1.5-5.7; p = 0.002). They were also more likely to have lower BMI (AOR=0.9; 0.9-1.0; p = 0.001) and report fewer pregnancies (AOR=0.6; 0.4-0.8; p = 0.001).
Conclusion: Endometriosis recurs in a significant proportion of cases following surgical management. A novel clinical phenotype associated with patient-reported recurrence of endometriosis was adenomyosis. Knowledge of the clinical risk factors related to recurrence will assist with better patient stratification and recurrence risk prediction.