Journal of the European Society for Gynaecological Endoscopy


The severity and frequency distribution of endometriosis subtypes at different ages: a model to understand the natural history of endometriosis based on single centre/single surgeon data

P.R. Koninckx 1,2,3,4,9,10, A. Ussia 3,4, A. Wattiez 1,5, L. Adamyan 6, D.C. Martin 7, S. Gordts 8

1 Latifa Hospital, Dubai, United Arab Emirates
2 ObGyn KULeuven Belgium
3 Gruppo Italo Belga, Villa Del Rosario Rome, Italy
4 Università Cattolica, Rome, Italy
5 Department of Obstetrics and Gynaecology, University of Strassbourg, France
6 Department of Operative Gynecology, Federal State Budget Institution V. I. Kulakov Research Centre for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia; and Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, Moscow, Russia
7 University of Tennessee Health Science Centre, Memphis Tennessee, USA, Institutional Review Board, Virginia Commonwealth University, Richmond, Virginia, USA
8 Leuven Institute for Fertility & Embryology, Leuven Belgium
9 University of Oxford-Honorary consultant, UK
10 Moscow State Univ


Endometriosis, endometriosis natural history, endometriosis growth, endometriosis prevention

Published online: Sep 24 2021


Background and Objective: to study the natural history of endometriosis.

Materials and methods: the analysis of all women (n=2086) undergoing laparoscopy for pelvic pain and endometriosis between 1988 and 2011 at University Hospital Gasthuisberg.

Main outcome measures: the severity of subtle, typical, cystic and deep endometriosis in adult women, with or without a pregnancy, as estimated by their pelvic area and their volume.

Results: the number of women undergoing a laparoscopy increased up to 28 years of age and decreased thereafter. Between 24 and 44 years, the severity and relative frequencies of subtle, typical, cystic and deep lesions did not vary significantly. The number of women younger than 20 years was too small to ascertain the impression of less severe lesions. The severity of endometriosis lesions was not less in women with 1 or more previous pregnancies or with previous surgery. There was no bias over time since the type and severity of endometriosis lesions remained constant between 1988 and 2011.

Conclusions: severity of endometriosis does not increase between 24 and 44 years of age, suggesting that growth is limited by intrinsic or extrinsic factors. Severity was not lower in women with a previous pregnancy.

What is new: considering the time needed for lesions to become symptomatic together with the diagnostic delay, the decreasing number of laparoscopies after age 28 is compatible with a progressively declining risk of initiating endometriosis lesions after menarche, the remaining women being progessively less susceptible.