Epidemiology

The true prevalence of endometriosis in the general population is unknown. Estimates of its prevalence are based on visualization of the pelvic organs. Pelvic endometriosis is present in approximately 1% of women undergoing major surgery for all gynecologic indications, 6% to 43% of women undergoing sterilization, 12% to 32% when laparoscopy is performed to determine the cause of pelvic pain in reproductive-age women, and 21% to 48% of women undergoing laparoscopy for infertility. Endometriosis is found in 50% of teenagers undergoing laparoscopy for evaluation of chronic pelvic pain or dysmenorrhea.

The influence of age, socioeconomic status, and race on the prevalence of endometriosis remains controversial. The age at time of diagnosis is commonly 25 to 35 years, and endometriosis rarely is diagnosed in postmenopausal women. Many believe that endometriosis is more common in women of upper economic classes because they delay pregnancy, which is postulated to increase the risk of developing endometriosis. It is unknown whether this reflects a true increased incidence or results from greater access to medical care. Evidence indicates that blacks have a prevalence of endometriosis similar to that in whites when controlled for socioeconomic status.

In patients with severe endometriosis and distortion of normal pelvic anatomy, the incidence of infertility is high because of impaired ovum pickup and tubal transport mechanisms. However, some patients with minimal endometriosis and normal pelvic anatomy are also infertile and may have an increased incidence of luteal phase dysfunction, luteinized unruptured ovarian follicle syndrome (" trapped oocyte" ), increased peritoneal prostaglandin production, and/or increased peritoneal macrophage activity to account for their decreased fertility.

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