Clinical manifestations and recurrence rates of various forms of extragenital endometriosis

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Abstract

Objective: This study aimed to evaluate the clinical and anamnestic data of patients with different forms of extragenital endometriosis (EGE), considering previous surgical interventions.

Materials and methods: A cross-sectional study was conducted at the V.I. Kulakov NMRC for OG&P from 2021 to 2023. The study involved 200 patients (mean age: 32.03 (7.15) years) with EGE, diagnosed using pelvic ultrasound (US) and magnetic resonance imaging (MRI). Patients were categorized into 3 groups based on the form of endometriosis: peritoneal endometriosis (PE), endometrioid cysts (EC), and deep endometriosis (DE). In cases of combined pathology, inclusion in a specific group was determined based on the most severe form of EGE. Women’s complaints were obtained through interviews, questionnaires, and comprehensive analysis of clinical and anamnestic data, including previous surgical and drug treatments.

Results: The study revealed that one in every three patients had complaints not typically associated with endometriosis. In every third case, the EC was incidentally identified using ultrasonography. When specifically questioned, 23.4% of patients with EC did not experience the characteristic pelvic pain associated with endometriosis, compared to 10.0% in the PE group and only 2.7% in the DE group. One in every three patients had undergone at least one previous surgical intervention, with 30.2% of them not receiving suppressive hormone therapy and 39.7% receiving short courses. Subsequently, the recurrence rate was 94.7% among patients who did not receive hormone therapy and 92% among those who received a short course of suppressive hormone therapy, irrespective of hormone therapy type. After previous surgical treatment for PE and EC, 48.7% of patients were subsequently diagnosed with DE. Among patients with previous surgery for EC, 41.9% experienced EC recurrence and 54.8% progressed to DE, whereas DE recurred to the same form of EGE in 85.7% of cases.

Conclusion: In one in every three cases, patients with EGE presented with complaints that were not typical of endometriosis. A targeted collection of complaints and medical history can aid in suspecting endometriosis as early as the initial outpatient visit, thereby reducing the time before diagnosis and treatment. Short courses of suppressive hormone therapy, regardless of type, do not prevent recurrence or progression of endometriosis after surgical treatment.

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About the authors

Veronika A. Pronina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Author for correspondence.
Email: ver22595@yandex.ru
ORCID iD: 0000-0003-4566-4065

obstetrician-gynecologist, PhD student at the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Russian Federation, Moscow

Anastasia V. Sokolova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: stasia0590@mail.ru
ORCID iD: 0000-0002-1197-3575

PhD, obstetrician-gynecologist at the Department of Gynecological Endocrinology, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Russian Federation, Moscow

Galina E. Chernukha

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: c-galina1@yandex.ru
ORCID iD: 0000-0002-9065-5689

Dr. Med. Sci., Professor, Chief Researcher, obstetrician-gynecologist at the Department of Gynecological Endocrinology, Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Frequency and structure of forms of endometriosis in patients included in the study (n=200)

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3. Fig. 2. Frequency of previous surgical treatment of endometriosis in different age groups

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4. Fig. 3. Structure of the leading complaints of patients with endometriosis

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