INTRODUCTION: To re-assess the coexistence of histology-proven endometriosis in women with symptomatic leiomyomas. Reappraisal of our previous study performed in 2010.
METHODS: Retrospective review of a prospective data-based collection of 244 medical records from patients who were treated for symptomatic leiomyoma from March 2011 to November 2014. 208 patients underwent laparoscopic, laparoscopic-assisted myomectomy (with and without robot assistance) or hysterectomy. All patients were consented for possible concomitant diagnosis and treatment of endometriosis. The remaining 36 patients underwent medical therapy and were excluded from the study. Patients who had myomectomy or supracervical hysterectomy, underwent mini-laparotomy for extracorporeal morcellation and specimen removal starting in April 2012.
RESULTS: Of the 208 patients who underwent surgical therapy, 181 were diagnosed with concomitant leiomyomas and endometriosis, while 27 were diagnosed only with leiomyomas. Of those 27 patients, 9 of them also had adenomyosis. Patients with only fibroids were on average 4.0 years older than those with endometriosis and fibroids (Mean age 44 vs 40). Patients with both diagnoses were also more likely to present with pelvic pain and nulliparity than those with fibroids alone.
CONCLUSION: Supportive of our previous report, the vast majority of patients with symptomatic fibroids were also diagnosed with histology-proven endometriosis. This updated and broader review reaffirms the need to concomitantly diagnose and treat both conditions, intraoperatively. Overseeing the diagnosis of endometriosis may lead to suboptimal treatment of fertility, persistent pelvic pain, and possible oncology-related concerns. Physicians must be aware of this association, in order to provide improved patient care.
Financial Disclosure: Dr. Nezhat (Dr. Nezhat Medical Center) disclosed the following—Storz, Surgiquest, Plasma Surgical: Consultant/Advisory Board. The other authors did not report any potential conflicts of interest.
© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.