A ultrassonografia na avaliação da endometriose: análise dos dados epidemiológicos e clínicos

Abstract

lntroduction: Endometriosis is a disease with a variable prevalence, which is considered to be around 10%. lt affects young women, the majority under 35 of reproductive age and productive from a socio-economic viewpoint, with their quality of life impaired by symptoms associated with pain, fatigue, depression, as well as infertility. Therefore, it should be considered a public health problem. The main symptoms associated with this disorder are pain related to the menstrual period, such as dysmenorrhea, dyspareunia, dyschezia, and dysuria, with chronic acyclic pelvic pain also playing an important role, as well as infertility. Diagnosis is an important part of this process, since the reality for these patients today is a significant delay in diagnosis, on average six to seven years, with a loss of quality of life affecting around 180 million women worldwide. Clinicai suspicion based on painful symptoms and/or infertility, followed by imaging diagnosis obtained by ultrasound as a first-line method already widely recognized for its accuracy in diagnosing this pathology, has played an increasingly important role. ln this study, we evaluated the performance of this important diagnostic tool based on its association with clinicai symptoms of pain and/or infertility, seeking to establish correlations with the location, type and intensity of pain and ultrasound findings, as well as evaluating the profile of ultrasound findings of endometriosis and their correlation with painful symptoms in infertile patients. Objectives: To analyze the clinicai and epidemiological profile of patients with an ultrasound diagnosis of endometriosis. To check whether there is a correlation between symptoms and ultrasound findings associated with endometriosis, as well as to assess the possible relationship between infertility and ultrasound findings. Material and Method: This was an observational cross-sectional study of 1001 female patients with complaints of pain and/or infertility who were referred for specialized deep endometriosis mapping with bowel preparation by experienced examiners. Patients were assessed for symptoms, epidemiological data and ultrasound findings. Results: A demographic profile with some specific characteristics was found among the patients evaluated, as well as a high prevalence of painful symptoms and/or infertility in addition to a high prevalence

of positive ultrasound findings for endometriosis in the population. Intensa dysmenorrhea was found in 70.9% of the patients, with 58.07% reporting chronic pelvic pain, 66.91o/o dyspareunia, 41.75% dysquezia, 22.93% dysuria and 25.31% infertility. Regarding ultrasound findings, 75.05% had at least one positive finding. Discussion: To the best of our knowledge, there are few studies that correlate epidemiological data with clinicai symptoms such as pain and/or infertility in selected populations, utilizing specialized ultrasound with prior bowel preparation, performed by specialists for the diagnosis of endometriosis. A relationship between painful symptoms and/or infertility has been associated with the presence of endometriosis and this diagnostic tool. Considered a first-line examination, it is applied to a population previously selected based on clinicai suspicion derived from clinicai data and physical examination, and properly referred to specialized care centers. This approach has the potential to inform effective strategies and cost management for the treatment and management of patients requiring clinicai and/or surgical intervention to improve their quality of life. Conclusion: The epidemiological profile of patients with clinicai suspicion of endometriosis in this study reveals a mean age of 35 years, with a predominance of individuais identifying as mixed race, non-smokers, and not users of hormonal contraceptiva methods. Positive ultrasonographic findings for endometriosis increase with age, which may suggest a delayed access to healthcare services. Among patients utilizing hormonal contraceptiva methods, there was a 20% higher prevalence of at least one positive ultrasonographic finding for endometriosis, potentially reflecting a greater reliance on hormonal suppression for pain management, abnormal uterina bleeding, or contraception. Clinically, the most prevalent pain symptoms associated with endometriosis {visual analog scale for pain >7) were dysmenorrhea (70.9%), dyspareunia (66.91%), chronic pelvic pain (58.07%), dyschezia (41.75%), and dysuria (22.93%). ln relation to infertile patients, there was an observed association with at least one positive ultrasonographic finding of endometriosis, which was 8% higher than in non­ infertile patients.