Prevalence of occult microscopic endometriosis in clinically negative peritoneum during laparoscopy for chronic pelvic pain

• Published in: International journal of gynecology and obstetrics 2020-11, Vol.151 (2), p.260-266
• Main Authors: Gubbels, Ashley L., Li, Rui, Kreher, Donna, Mehandru, Natasha, Castellanos, Mario, Desai, Nita A., Hibner, Michael
• Format: Article
• Language: English
• Subjects: Adult; Arizona - epidemiology; Chronic Pain - etiology; Chronic pelvic pain; Cross-Sectional Studies; Endometriosis; Endometriosis - complications; Endometriosis - epidemiology; Female; Humans; Laparoscopy; Microscopic endometriosis; Negative laparoscopy; Occult endometriosis; Occult microscopic endometriosis; Pain Measurement; Pelvic Pain - etiology; Peritoneum - pathology; Prevalence; Retrospective Studies; Young Adult
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.13303

Objective  To determine the prevalence of occult microscopic endometriosis in patients with chronic pelvic pain and negative laparoscopy. Methods A retrospective cross‐sectional study included women who underwent laparoscopic evaluation for chronic pelvic pain by three fellowship‐trained gynecologic surgeons at a community hospital from January 2011 to December 2016. The aim was to evaluate the prevalence of microscopic endometriosis in this population. Results  In 142 patients with clinically negative peritoneum on laparoscopy, 39% had occult microscopic endometriosis. Cramping pain score during menses was found to be lower in the positive biopsy group (6.9 vs 8.0, P=0.046). No differences were appreciated in age of menarche, pain during various parts of the menstrual cycle, or duration of symptoms. The biopsy‐positive group had a younger age at time of evaluation, although not statistically significant (P=0.179). Current use of hormones affected neither biopsy results nor menstrual or pain characteristics. Detection was similar between robotic and laparoscopic cases and operative morbidity was minimal. Conclusion Occult microscopic endometriosis may be present in approximately 39% of patients with clinically negative appearing peritoneum undergoing laparoscopy for chronic pelvic pain. Given this, biopsies should be performed in patients undergoing laparoscopy who do not have visible lesions. Occult microscopic endometriosis may be found in up to 39% of patients undergoing laparoscopy for chronic pelvic pain.