BACKGROUND: There is limited data on endometriosis from the Eastern Mediterranean region. This study for the first time estimates the prevalence and impact of endometriosis on women in Northern-Cyprus, an under-represented region in Europe.
METHODS: Cyprus Women’s Health Research(COHERE) Initiative, a cross-sectional study recruited 7,646 women aged 18-55 in Northern-Cyprus between January 2018-February 2020. Cases were identified using self-reported and ultrasound data and two control groups were defined, with(n=2,922) and without(n=4,314) pain. Standardised tools, including the 11-point Numerical-Rating-Scale and the Short-Form-36-Health-Survey-version-2, were used to assess pain and quality-of-life, respectively.
RESULTS: Prevalence and median diagnostic-delay of endometriosis was 5.4%(95%CI:4.9%-5.9%, n=410) and 7(IQR:15.5) years. Endometriosis cases experienced a higher prevalence of bladder-pain compared to asymptomatic-pain-controls(6.3% vs 1.0%, p<0.001) and irritable-bowel-syndrome relating to pelvic-pain compared to symptomatic(4.6% vs 2.6%, p=0.027) and asymptomatic(0.3%, p<0.001) controls. The odds of endometriosis cases reporting an anxiety diagnosis was 1.56(95%CI:1.03-2.38) higher than the symptomatic and 1.95(95%CI:1.30-2.92) times higher than the asymptomatic controls. The physical-component-score of the health-related-quality-of-life instrument suggested a significant difference between the endometriosis cases and the symptomatic-controls(46.8 vs 48.5, p=0.034). Average annual economic cost of endometriosis cases was Int$9,864(95%CI:$8,811-$10,917) including healthcare, costs relating to absence and loss of productivity at work.
CONCLUSION: Prevalence was lower than the global 10% estimate, and substantial proportion of women without endometriosis reported moderate/severe pelvic-pain hinting at many undiagnosed cases within this population. Coupled with lower quality-of-life, significant economic-burden and under utilised pain management options, the study highlights multiple opportunities to improve care for endometriosis patients and women with pelvic-pain.
