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PubMed2006

Endometriosis in patients with chronic pelvic pain: is staging predictive of the efficacy of laparoscopic surgery in pain relief?

BACKGROUND/AIMS: Endometriosis is considered an important cause of chronic pelvic pain. Despite its high prevalence, controversy still exists regarding the true association between the extent of endometriosis and the severity of symptoms. We conducted this prospective study to investigate the association between the stage of endometriosis and type and severity of pain, and to evaluate the efficacy of laparoscopic surgery in pain relief. METHODS: Ninety-five patients complaining of chronic pain were diagnosed with endometriosis and were treated with laparoscopic surgery. The severity of pain was assessed in patients with an endometriosis AFS (American Fertility Society) score less than 16 (group 1) and those with an AFS score greater than or equal to 16 (group 2), preoperatively and 6 months after surgery, using a visual pain scale. Any reduction in pain scores by 2 points or more was considered to be an improvement. RESULTS: Dysmenorrhea and deep dyspareunia, were significantly more frequent in patients of group 2. Preoperative pain scores were significantly higher for dysmenorrhea (p = 0.0022) and deep dyspareunia (p < 0.0001) but not for non-menstrual pain in group 2. Deep dyspareunia was correlated with the presence of dense pelvic adhesions. After surgery, dysmenorrhea improved in 43% of cases in group 1, vs. 66% of cases in group 2 (p = 0.0037). For deep dyspareunia, improvement was reported by 33% in group 1, vs. 67% in group 2 (p = 0.074). Improvement in non-menstrual pain was not significantly different between the two groups (67% vs. 56%). CONCLUSIONS: Advanced endometriosis is more frequently related to dysmenorrhea and deep dypareunia in comparison to early disease. Laparoscopic surgery may offer relief or improvement in the majority of patients with endometriosis and chronic pelvic pain. Cases with advanced disease seem to benefit the most.

Chronic Disease↗

PubMed2006

The prevalence of endometriosis in women with chronic pelvic pain.

BACKGROUND: The 2004 American College of Obstetrics and Gynecology clinical management guideline states that the prevalence of endometriosis is approximately 33% in women with chronic pelvic pain (CPP). This estimate came from a review showing that 28% of adult women with CPP were found to have endometriosis. The prevalence of 28% in adult women was arrived based on a compilation of 11 published studies. Yet even within the 11 studies, the reported prevalence of endometriosis varies wildly, ranging from 2 to 74%. Such an astounding variation or heterogeneity raises the question whether it is appropriate to use a single prevalence of endometriosis for all women with CPP. METHODS: We sought to identify possible sources of heterogeneities in the estimation of prevalence of endometriosis in women with CPP. We included more studies that reported prevalence estimates than the review, and examined the effect of sample size and the year of publication on the heterogeneity. RESULTS: The year of publication is positively associated with the prevalence estimate, which may indicate an increasing awareness of various appearances of endometriosis, or the prevalence of endometriosis may have increased among women with CPP. An alternative analysis with removal of four studies reporting highest prevalence estimates indicated that sample size is negatively associated with the prevalence estimates while the year of publication became only marginally significant. CONCLUSIONS: There are identifiable sources of heterogeneity in prevalence estimates, with the year of publication, sample size, and difference in evaluation of CPP being three apparent sources. Having a single prevalence estimate for all women with CPP may be too simplistic at best. The true prevalence is very likely to be higher than 33%.

Adult↗

PubMedDate not supplied

More than just menstrual cramps: symptoms and uncertainty among women with endometriosis.

OBJECTIVE: To examine the frequency, severity, interference with daily life, and symptom distress associated with endometriosis and to explore the relationships among symptoms, emotional distress, uncertainty, and preference for and adequacy of information. DESIGN: A descriptive, cross-sectional correlational study. SETTING: Data were collected at a conference of the Endometriosis Association in Milwaukee, Wisconsin. PARTICIPANTS: A convenience sample of 298 women attending an educational program. MAIN OUTCOME MEASURES: Endometriosis symptoms and symptom distress, emotional distress, and adequacy of information were assessed using author-developed scales. Preference for information was measured by a revision of the Krantz Health Opinion Survey Information Subscale. Uncertainty was assessed using the Mishel Uncertainty in Illness Scale-Community Form. RESULTS: Women experienced multiple symptoms associated with varying levels of distress, including symptoms not typically associated with endometriosis. Participants sought out information but were undecided about whether they had sufficient information about the disease. Uncertainty about endometriosis was relatively high and associated with emotional distress and lack of information about the disease. CONCLUSIONS: Reported symptoms demonstrate the complexity and impact of endometriosis. Women's preference for information and experience of emotional distress and uncertainty suggest the need for information and support. Prospective, controlled studies on the impact of endometriosis and interventions to inform and support patients are needed.

Activities of Daily Living↗

PubMed2003

Potential involvement of the immune system in the development of endometriosis.

This article presents an overview of immunological factors and their role in the development of endometriosis, with emphasis on inflammatory cytokines, growth and adhesion factors. Although retrograde menstruation is a common phenomenon among women of reproductive age, not all women who have retrograde menstruation develop endometriosis. The development of endometriosis is hypothesised to be a complex process, which may be facilitated by several factors, including the quantity and quality of endometrial cells in peritoneal fluid (PF), increased inflammatory activity in PF, increased endometrial-peritoneal adhesion and angiogenesis, reduced immune surveillance and clearance of endometrial cells, and increased production of autoantibodies against endometrial cells. Potential biomarkers like cytokines and autoantibodies upregulated during development of endometriosis may be useful in the development of a non-surgical diagnostic tool. Although endometriosis can be treated using hormonal suppression, there is need for non-hormonal drugs, which can inhibit the development of endometriosis and alleviate pain or infertility without inhibition of ovulation. New molecules that modulate immune function in endometriosis should be the targets for future research.

Endometriosis↗

PubMed1986

Treatment of endometriosis in monkeys: effectiveness of continuous infusion of a gonadotropin-releasing hormone agonist compared to treatment with a progestational steroid.

The use of a GnRH agonist or a progestational steroid (levonorgestrel) for the treatment of endometriosis in monkeys was compared. Four monkeys with spontaneous endometriosis were treated for 6 months with a continuous infusion of a GnRH agonist (25 micrograms/day). Five animals with surgically induced endometriosis were treated with the same agonist for 3 months. An additional group of five monkeys with surgically induced endometriosis was treated orally with levonorgestrel (1 mg/kg X day), while a final group of four monkeys served as untreated controls. During agonist treatment, the four monkeys with spontaneous endometriosis gained body weight and had a greater than 80% decline in cyst size (representing a decline in secretory activity). Monkeys with surgically induced endometriosis had almost total resolution of endometrial lesions during agonist treatment, which was maintained throughout a 4-month posttreatment period. After initial stimulation at the onset of the GnRH agonist infusion, serum LH, FSH, estradiol, and progesterone levels decreased to near the levels of detection, where they remained until treatment was terminated. In comparison, levonorgestrel reduced endometrial lesion size, but the monkeys did not resume normal cycles as early as those treated with the agonist. Levonorgestrel-treated monkeys had normal serum LH and FSH levels, but low serum estradiol and progesterone levels. The results of this study indicate that either continuous infusion of a GnRH agonist or administration of levonorgestrel is effective for treating endometriosis in monkeys. The hormonal data suggest that the GnRH agonist acts at the level of the hypothalamus and pituitary, whereas levonorgestrel acts at the ovarian level.

Animals↗

PubMed2001

Expression of scavenger receptor class B1 in endometrium and endometriosis.

Endometriosis is characterized by the presence of endometrial glands and stroma within the peritoneum and other extrauterine sites. The presence of aromatase, a key enzyme in the biosynthesis of estradiol, has been demonstrated in eutopic endometrial samples of women with moderate to severe endometriosis, but not in those of disease-free women. Animal studies have shown that high density lipoprotein provides precursor cholesterol pool for steroidogenesis. Scavenger receptor class B1, a 82-kDa cell surface protein, is involved in the binding of high density lipoprotein to target cells and promotes cholesteryl ester uptake. In this study we detected the presence of scavenger receptor class B1 in eutopic and ectopic endometrium. There was more scavenger receptor class B1 protein associated with endometriosis compared with matched endometrium. Two bands (82 and 45 kDa) were detected in the endometrium and endometriosis samples. Glycanase treatment indicated that the 45-kDa protein might be a nonglycosylated form of scavenger receptor class B1. Immunostaining of fixed tissues detected scavenger receptor class B1 in glandular epithelium of both tissues. Scavenger receptor class B1 and aromatase mRNA were increased in endometriosis tissues. Scavenger receptor class B1 expression in the endometrium and endometriosis supports a role for this receptor in the uptake of high density lipoprotein cholesterol, possibly supporting in situ estrogen production, which is detrimental in the progression of endometriosis.

Adult↗

PubMed1995

Immunoresponsiveness in endometriosis: implications of estrogenic toxicants.

Endometriosis is a reproductive disease characterized by the growth of endometrial cells at sites outside the uterus. This disease is a serious disorder associated with chronic pain and infertility, which may be present in 6 million women in this country. Traditional medical therapy has consisted of hormonal regimens that limit the action of endogenous estrogen. The etiology of endometriosis is unknown, but studies suggest that soluble factors known as cytokines play a role in disease pathogenesis. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD or dioxin) is an environmental toxicant that alters the action of estrogen in reproductive organs and adversely affects immunocompetence. The incidence of endometriosis was determined in rhesus monkeys that were chronically exposed to dioxin for a period of approximately 4 years. Ten years after termination of dioxin treatment, the presence and severity of endometriosis was assessed by surgical laparoscopy. The incidence of endometriosis correlated with dioxin exposure and disease severity was dependent upon the dose administered. Moderate to severe endometriosis was not found in control animals but was documented in three of seven animals exposed to 5 ppt dioxin (43%) and in five of seven animals exposed to 25 ppt dioxin (71%). The frequency of spontaneous disease in the control group was 33%, similar to an overall prevalence of 30% in 304 rhesus monkeys with no history of dioxin exposure. This study indicates that endometriosis may be associated with dioxin exposure in the rhesus. In view of overwhelming evidence that cytokines participate in the mediation of reproductive-endocrine phenomena and regulation of endometrial growth, future assessment of the effects of environmental toxicants on reproductive health may depend upon our understanding of the bidirectional cytokine network between the immune and endocrine systems.

Animals↗

PubMed1999

Expression of Ah receptor and dioxin-related genes in human uterine endometrium in women with or without endometriosis.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) has been suggested as a possible etiologic factor for endometriosis, a condition in which endometrium-like tissues are present outside the uterus. The prevailing view pertaining to the origin of endometriotic cells is that they are from eutopic endometrial cells which regurgitate through fallopian tubes. In order to get insight into the possible involvement of TCDD in the pathogenesis of endometriosis, we suspected that TCDD may act differently on the endometrium with or without endometriosis. To address this, we examined the presence of messenger RNAs of arylhydrocarbon receptor (AhR), AhR nuclear translocator (Arnt) and two dioxin-responsive genes, cytochrome P-450 1B1 (CYP1B1) and downstream of tyrosine kinases (p62(dok)), in the endometrium of women with or without endometriosis using semi-quantitative reverse transcription-polymerase chain reaction. All the genes were expressed throughout the menstrual cycle. The expression level of p62(dok) was higher in the proliferative phase than in the secretory phase. In contrast, the expression levels of AhR, Arnt and CYP1B1 seemed to be constant during the cycle. In terms of the comparison between non-endometriosis and endometriosis group, the mRNA levels of AhR, Arnt, CYP1B1 and p62(dok) were essentially similar. Interestingly, AhR mRNA level was significantly lower in smokers than in non-smokers. Based on the regression analysis, significant linear and positive correlations were observed between AhR and Arnt mRNA levels, and between Arnt and p62(dok) mRNA levels. In summary, expression of AhR and dioxin-related genes in the endometrium did not differ in women with or without endometriosis.

Adult↗

PubMed2004

Emerging drugs for endometriosis.

Medical treatment of endometriosis relies on drugs that suppress ovarian steroids and induce an hypoestrogenic state that causes atrophy of ectopic endometrium. Gonadotrophin-releasing hormone (GnRH) analogues, danazol, progestogens and oestrogen-progestin combinations have all proven effective in relieving pain and reducing the extent of endometriotic implants. However, symptoms often recur after discontinuation of therapy and hypoestrogenism-related side effects limit the long-term use of most medications. Furthermore, these therapies are of limited value in patients with a desire to become pregnant because they inhibit ovulation. An important target for current research is to identify effective therapies that can be safely administered in the long term. GnRH analogues with add-back therapy, progestogens and continuous oral contraceptive are options available for a medium or long-term systemic treatment. Mifepristone, an antiprogestogen, may constitute an alternative if encouraging preliminary data on its effectiveness and tolerability are confirmed. A very appealing area of interest is the possibility of treating endometriosis without suppressing ovarian function. Aromatase inhibitors might have such characteristics as they have been shown to inhibit oestrogen production selectively in endometriotic lesions, without affecting ovarian function; the clinical role of these drugs in the treatment of endometriosis is under evaluation. Levonorgestrel medicated intrauterine device has proven effective in relieving dysmenorrhoea associated with endometriosis, as well as pain associated with rectovaginal endometriosis. Although a systemic absorption is present determining side effects, this approach is promising in the long-term management of this condition. A fundamental objective of research in endometriosis treatment is to develop new therapeutic approaches based on the findings from experimental studies on the aetiopathogenesis of the disease; current research is focusing on anti-inflammatory drugs and modulators of the immune system. TNF-binding protein-1 and IL-12 have proved effective in reducing endometriotic lesions in animal models, while pentoxifylline and INF-alpha 2b have shown encouraging results in clinical studies. This area may be of paramount importance in the near future in order to develop a therapy that could prevent or eradicate endometriosis rather than merely relieving the symptoms.

Adult↗

PubMed1994

The role of macrophage colony stimulating factor in the peritoneal fluid in infertile patients with endometriosis.

Macrophage colony stimulating factor (M-CSF) concentrations in the peritoneal fluid of 44 infertile patients were measured. The concentration of M-CSF was significantly higher in the patients with endometriosis than in those without endometriosis. There was no significant difference between the M-CSF concentration and stage of endometriosis classified by revised American Fertility Society (rAFS) classification in the 44 patients. However, in primary infertility patients with endometriosis there was a significant correlation between peritoneal M-CSF levels and rAFS points of endometriosis. We speculate that there is some relationship between the increased levels of M-CSF in the peritoneal cavity and the primary infertility associated with endometriosis especially progression of endometriosis.

Ascitic Fluid↗

PubMed2001

Endometriosis: aetiology, pathogenesis and treatment.

Endometriosis, which may be defined as the presence and proliferation of endometrial tissue outside the uterine cavity, causes pain and infertility for millions of women worldwide. Studies suggest a prevalence of 0.5 to 5% in fertile and 25 to 40% in infertile women. The most widely accepted aetiological theory is that retrograde flow of menstrual fluid through the Fallopian tubes deposits viable endometrial tissue, which implants on the peritoneal surface. Increasingly, the aetiology of endometriosis is being studied at the immunological and genetic levels. The aim of treatment of endometriosis is to remove or diminish disease deposits. This may be attempted through medical or surgical means. It has long been recognised that endometriotic glands are hormonally sensitive. Medical therapies work by inducing a hypoestrogenic, anovulatory state to induce atrophy within the glandular tissue. Conception is generally not possible during medical therapy and has not been demonstrated to increase afterwards. Medical treatment of endometriosis should be discouraged when infertility is the primary problem. In this situation surgery or an assisted reproduction treatment such as in vitro fertilisation may be more appropriate. Medical treatment of pain caused by endometriosis is generally effective. There is little difference in efficacy between the different medications but their adverse effect profiles differ greatly. It appears that gonadotropin-releasing hormone agonists, particularly when used with add-back estrogen, may be more acceptable to women than other treatments. Laparoscopic surgical treatment of minimal and mild endometriosis has been demonstrated to increase fecundity. Surgical treatment has also been shown to decrease pain scores compared with expectant management. Ongoing and future research examining the aetiology of endometriosis at the immunological and genetic levels should usher in new treatments directed at the actual cause of the disease. More randomised trials examining the role of surgery, and comparing surgical and medical treatments, are also required and are necessary if we are to continue in our attempts to adopt an evidence-based approach to treatment.

Endometriosis↗

PubMed1994

Solid pelvic masses caused by endometriosis: MR imaging features.

OBJECTIVE: Solid fibrotic nodules of endometriosis can simulate peritoneal metastases on imaging studies. To assist with this distinction, we analyzed the MR appearance of solid masses of pelvic endometriosis. MATERIALS AND METHODS: A search of pathologic and surgical records of patients who had pelvic MR imaging with a phased-array multicoil disclosed 13 patients who had endometriosis proved at laparotomy. MR images were reviewed retrospectively by two unblinded radiologists for the signal intensity, size, and enhancement pattern of solid peritoneal masses. Eight solid masses in six patients were detected on MR images: four lesions were in the cul-de-sac, two in the bladder wall, and two in the rectal wall. Four of the masses were excised at surgery and one was sampled by surgical biopsy; microscopy showed abundant fibrosis with small clusters of endometriotic glandular tissue. Three masses were inspected at surgery and found to represent dense fibrosis caused by endometriosis. RESULTS: Solid masses of endometriosis ranged in size from 1 to 5 cm. Seven of the eight masses had similar features on MR images: intermediate signal intensity on T1-weighted spin-echo images with punctate foci of high signal intensity, low signal intensity on T2-weighted images, and enhancement after administration of contrast material. CONCLUSION: MR imaging shows enhancing solid masses in some patients with endometriosis. These masses have MR features that might be useful in the differentiation between solid foci of endometriosis and peritoneal metastases.

Adult↗

PubMed2003

Endometriosis is associated with alterations in the relative abundance of proteins and IL-10 in the peritoneal fluid.

A growing body of evidence suggests that endometriosis modulates the microenvironment of peritoneal cavity. Therefore, in this study, we compared the protein profile of peritoneal fluids from normal fertile women with those from patients with infertility, and patients with mild to severe endometriosis. Two-dimensional gel electrophoresis of peritoneal fluids from normal subjects exhibited a distinct and reproducible pattern of proteins in the size ranges of approximately 35 to 80 kD and pI close to 4.5 to 6.6. Infertility without evidence of endometriosis was not associated with changes in the relative abundance of proteins present in the peritoneal fluid. However, mild endometriosis was associated with a mild reduction in the amount of several peritoneal protein spots with the approximate molecular weights of 35-40 kD and pI close to 5.7-6.0. These changes became markedly apparent in the peritoneal fluid of patients who suffered from the severe form of this disease. Severe endometriosis was also associated with appearance of protein spots in the gels that were not detectable in the peritoneal fluids of normal subjects. Consistent with these data, enzyme-linked immunosorbent assay showed that moderate to severe endometriosis was associated with markedly elevated levels of IL-10 in the peritoneal fluid. Reverse transcription followed by polymerase chain reaction amplification using primers specific to IL-10 confirmed presence of IL-10 mRNA in cells derived from peritoneal fluids. These findings show that endometriosis is associated with disturbed secretion of proteins into the peritoneal cavity and with an elevated level of IL-10 in the peritoneal fluid. The studies also show cells resident in peritoneum as a major source of IL-10.

Ascitic Fluid↗

PubMed1997

Endometriosis: a review on its pathogenesis.

Although peritoneal endometriosis was recognized in 1860, its pathogenesis still remains unclear. Several theories attempt to explain the pathogenesis of this condition. From these, the implantation theory maintains that peritoneal endometriosis is the result of implantation and subsequent growth of retrogradely shed viable endometrial cells. Based on a second theory, the peritoneal mesothelium transforms to an endometrium-like tissue under the influence of products of regurgitated endometrium (induction). Cell adhesion molecules could be functionally involved in the binding of the endometrial cells to the peritoneal lining. In peritoneal endometriosis, a delicate equilibrium seems to exist between attacking forces (retrograde menstruation) and the defense mechanisms. On one hand, the amount and the nature of the regurgitated menstrual debris seems important to the development of the disease. On the other hand, the active intra-abdominal milieu may be involved. This milieu probably converts the regurgitated endometrial tissue into single cells via loss of functional cell adhesion properties. Endometriosis may result form the impairment of the function of the peritoneal milieu in disposing of the regurgitated cells. Alternatively, the endometriosis may occur if the number of regurgitated cells is too large. An intact peritoneal lining may be an important additional line of defense in preventing the binding of the endometrial cells. Endometriosis is likely to develop if such defense mechanisms fail. Here, the scientific basis of the endometriosis theories is discussed.

Cell Adhesion↗

PubMed1994

CO2-laser excision of endometriosis does not improve the decreased natural killer activity.

OBJECTIVE: We recently described a decreased lymphocyte-mediated cytotoxicity to autologous endometrium and to natural killer-sensitive targets in women with endometriosis. The purpose of the present study was to investigate whether the defect remained after CO2-laser excision of the endometriotic lesions. DESIGN: In 15 women with endometriosis the cytotoxicity assays were performed before and three to four months after complete removal of the endometriotic lesions with CO2-laser excision. CA-125 serum levels were measured before and after laser laparoscopy, in order to confirm that endometriosis had been treated properly. RESULTS: After removal of the endometriotic lesions the decreased natural killer activity (K562-assay) and the impaired cytotoxicity of autologous and even heterologous lymphocytes to the endometrium remained unchanged, and those cytotoxicity assays were still significantly decreased compared to the women without endometriosis. CA-125 serum concentrations, however, were still significantly decreased three to four months after CO2-laser excision of the endometriosis. (paired Student's t-test p < 0.007). CONCLUSIONS: These data suggest a primary deficiency in natural killer activity in women with endometriosis and are in accordance with our clinical experience as endometriosis is relapsing frequently after treatment.

Carbon Dioxide↗

PubMed1996

Infertile women with and without endometriosis: a case control study of luteal phase and other infertility conditions.

OBJECTIVE: To assess the relationship in infertile women between endometriosis and luteal phase defects and other infertility conditions. SETTING: University Medical School. DESIGN: Case-control study. PATIENTS: One hundred and seventy-four infertile women with endometriosis and 174 infertile women without endometriosis, all of them studied by laparoscopy. The inclusion criteria were failure of six cycles of ovulation stimulation or abnormal preliminary study (abnormal pelvic physical, hysterosalpingographic or ultrasound findings). RESULTS: The frequency of out-of-phase biopsies (16.1% vs 16.7%) as well as other endometrial abnormalities were similar in endometriosis associated infertility (EAI) and in non-endometriosis infertility (NEI). Mean progesterone and prolactin levels, as well as the proportion of abnormal progesterone levels (37.4% vs 44.3%) and of hyperprolactinemia (12.9% vs 13.2%) were similar in EAI and NEI. The frequency of uterine myomas was similar in both groups. Sperm characteristics were not better in EAI than in NEI. Higher endometriosis stages were not associated with a higher frequency of the aforementioned conditions. CONCLUSION: Luteal phase defects, sperm abnormalities and myomas are no more common in EAI than in NEI or in advanced stages of endometriosis.

Adult↗

PubMed1996

Serum from endometriosis patients impairs the development of mouse embryos in vitro--comparison with serum from tubal obstruction patient and plasmanate.

BACKGROUND: The aim of this study was to evaluate the inhibitory effect of serum from endometriosis. To determine the effects of serum obtained from patients with endometriosis on mouse embryo development, we compared the fertilization and cleavage rates of mouse embryo in a standard mouse embryo culture system. METHODS: Sera were collected from 13 individuals who were diagnosed endometriosis and ten individuals who were diagnosed as having tubal obstruction. Mouse embryos were fertilized and cultured in vitro with serum supplement obtained from patients with endometriosis (n = 13) and tubal obstruction (n = 10), and plasmanate (n = 10). RESULTS: The fertilization rate was 26.6 +/- 14.9% in patients serum with endometriosis, and the cleavage rate was 21.2 +/- 9.1%, respectively. However, the fertilization rates were 60.9 +/- 12.5% (tubal obstruction group), and 77.3 +/- 14.7% (plasmanate group), the cleavage rates were 32.2 +/- 16.4% and 36.2 +/- 9.9%, respectively. CONCLUSIONS: Serum from patients with endometriosis revealed toxic effects on mouse embryos in vitro. The use of plasmanate instead of whole serum from patients with endometriosis will hopefully bring a better understanding of embryo development.

Adult↗

PubMed1997

Treatment of endometriosis involving a self-help group positively affects patients' perception of care.

Chronic endometriosis is notoriously difficult to treat and many women become frustrated with their care. We established an Endometriosis Clinic as a co-operative venture between a group of gynecologists and a self-help group, the Endometriosis Association of Victoria. The aim of this study was to examine the clinical characteristics of women attending the clinic and to determine patient satisfaction with the clinic. The study involved a review of patient histories and a postal satisfaction questionnaire. Three hundred and fourteen women attended the clinic during its first year of operation. Seventy per cent had had a diagnosis of endometriosis made elsewhere and attended the clinic for a second opinion or for more information. Eighty-six per cent presented with symptoms suggestive of endometriosis, 8% presented with infertility and 6% complained of both symptoms and infertility. When patients were asked to score the overall service provided by the clinic on a scale of 1 to 10, scores ranged from 4 to 10 with a mean of 8.7. Ninety-seven per cent of women felt that the consultation with a counselor from the Endometriosis Association was a major source of satisfaction. We have documented a significant demand for and high patient satisfaction with the concept of integrating a patient self-help group in the standard model of health care for endometriosis.

Adult↗