Long-term health outcomes in women with endometriosis

• Main Author: Saraswat, Lucky
• Other Authors: Bhattacharya, Siladitya ; Cooper, Kevin ; Ayansina, Dolapo
• Published: University of Aberdeen 2018
• Subjects: 618; Endometriosis
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.752689

Background: Endometriosis is a common, chronic gynaecological condition that affects women of reproductive age. Typically associated with symptoms of pelvic pain and infertility, endometriosis significantly impairs quality of life and poses a considerable socioeconomic burden. Surgery is the mainstay in the diagnosis and treatment of endometriosis. In symptomatic women, the condition can only be diagnosed or excluded by a laparoscopy (key-hole surgery). Recurrence of symptoms is common after both medical and surgical treatment and there is no known cure to date. The impact of endometriosis on long term health of women is poorly understood and relatively less well explored. Aim and Objectives: The aim of this thesis was to evaluate the impact of endometriosis on long-term health, with a focus on three key areas: pregnancy, further gynaecological surgery, and subsequent cancer. Methods: This was achieved through a set of cohort studies using Scotland wide data comprising more than 290,000 women with nearly 5 million (4,923,628) person years of follow up from 1981 to 2010. Women with a new surgical diagnosis of endometriosis during this period were compared to those without a diagnosis of endometriosis to evaluate pregnancy outcomes, risk of further gynaecological surgery and future cancer. Results: A diagnosis of endometriosis was associated with an increased risk of early pregnancy loss in the form of miscarriage or ectopic pregnancy. In ongoing pregnancies, those with endometriosis had a higher likelihood of placenta praevia, preterm birth or delivery by caesarean section. Endometriosis was associated with an increased risk of multiple surgical interventions, hysterectomy and/or removal of ovaries. Among cancers, ovarian cancer and malignant melanoma were more common in women with endometriosis compared to those without. Conclusions: The results from this thesis have improved our understanding of endometriosis and can be used to counsel women and inform clinical practice and health services planning.