Endometriosis symptom variation by mutually adjusted demographic characteristics in a cohort of 1000 women

Abstract

Study question Are demographic characteristics associated with thepresentation of pain symptoms (including severe dysmenorrea, severe acyclicpelvic pain, intestinal symptoms, cyclic urinary symptoms, deep dyspareunia) inpatients with endometriosis? Summary answer Age, race, education, and age at menarche weresignificant predictors, independent of each other, of severe dysmenorrhea. Severeacyclic pelvic pain was significantly associated with age, education, maritalstatus, and parity. Intestinal symptomswere significantly associated with race and age at menarche. What is known already Severe dysmenorrhea is the symptom most commonly relatedto the reduced quality of life in patients with endometriosis. Although theliterature has focused on quantifying pain symptoms associated withendometriosis, little is known about the distribution and variation of thesesymptoms by the patient's demographic characteristics. Study design, size, duration This prospective cohort study from 1998-2010 of 1002patients (median age = 33; range = 29-38) with laparoscopic and histologicalconfirmation of endometriosis who were unsuccessful treat by medication. Participants/materials, setting, methods Relative risks(RR) and 95%confidence intervals(CI) frommultivariable Poisson regression models adjusted for number of diseaselocations(1,2,3,4,5+), age at surgical diagnosis(14-24;25-29;30-34;35-39;40+), race(white;black;Asian),education(elementary;high school;university), marital status(single;married/partnered;divorced/widowed),age at menarche(≤11;12-13;14+), and parity(0;1;2+). This mutual adjustmentyields associations independent of the other characteristics investigated. Main results and the role of chance Patients aged 14-24 (RR = 1.27,CI = 1.06-1.51) and25-29 (RR = 1.18;CI = 1.04-1.35) were more likely to report severe dysmenorrheacompared to patients 30-34 at diagnosis. Black race compared to white (RR = 1.20,CI = 1.06-1.36), elementaryeducation compared to college (RR = 1.18,CI = 1.02-1.36), and ≤11 years old at menarchecompared to 12-13 (RR = 1.15,CI = 1.04-1.28) were also significantly associatedwith greater risk of severe dysmenorrhea. Increased risk of severe acyclic pelvic pain was found among youngerpatients (RR = 1.57,CI = 1.05-2.35 for those aged 14-24 versus 30-34) and parouspatients (RR = 1.47,CI = 1.15-1.87 versus nulliparous). Black race as compared to white(RR = 1.40,CI = 1.07-1.84) and younger age at menarche (RR = 1.26,CI = 1.03-1.55 for ≤ 11 versus 12-13) were associated with increased risk of intestinalsymptoms. No significant associationswere found between demographic characteristics and cyclic urinary symptoms ordeep dyspareunia. Limitations, reason for caution Due to missing data, we were only able toconsider body mass index, smoking, physical activity, and family history ofendometriosis as predictors of pain on a subset of patients, reducing power andpotentially generalizability for these additional demographic characteristics. Wider implications of the findings Not only do painsymptoms vary among women with endometriosis, these symptoms may be more commonwith specific demographic characteristics such as age at diagnosis, education,race, parity, and age at menarche. Thisvariation may lend insight into disease etiology or patterns of diagnostic delay/ bias. Study funding/competing interest(s) There was no fundingsupport for this project.