Women with endometriosis more likely to report lower urinary tract symptoms

Women who had laparoscopically diagnosed endometriosis were more likely to report lower urinary tract symptoms than those without the disorder, a cross sectional analysis showed.

A previous survey estimated that 6.1% of U.S. women aged 18 to 49 years have been diagnosed with endometriosis. According to WHO, the global prevalence of the condition among reproductive-aged women is approximately 10%.

Writing in Fertility & Sterility, Iwona Gabriel, MD, PhD, a research coordinator at Brigham and Women’s Hospital and director of clinical trials at the Medical University of Silesia in Poland, and colleagues noted that they previously linked pain during urination and more frequent urination to “menstrual pain presence and severity” in patients with endometriosis. However, whether patients with endometriosis are more likely to have lower urinary tract symptoms was unknown, they added.

The researchers analyzed symptoms among 520 women and girls with surgically confirmed endometriosis and 641 women and girls without the disorder who were enrolled in the Women’s Health Study: From Adolescence to Adulthood between 2012 and 2018. Most of the participants in both cohorts were white. The cohort without endometriosis included mostly women aged 18 to 25 years (58.3%) with a mean BMI of 24.1 kg/m², while the cohort with the disorder was mostly girls aged 18 years and younger (41.7%), with a mean BMI of 24.7 kg/m².

The findings indicated that participants with endometriosis, compared with those without the disorder, more frequently reported difficulty passing urine (7.9% vs. 2%; crude OR = 4.14; 95 CI, 2.19-7.8; adjusted OR = 4.31; 95% CI, 2.07-8.95); still feeling full after urination (18.8% vs. 4.7%; crude OR = 4.73; 95% CI, 3.08-7.25; aOR = 4.67; 95% CI, 2.88-7.56); needing to urinate again “within minutes” of urinating (33.1% vs. 17%; crude OR = 2.41; 95% CI, 1.83-3.18; aOR = 2.49; 95% CI, 1.81-3.43); dysuria (11.7% vs. 4.9%; crude OR = 2.55; 95% CI, 1.62-4.01; aOR = 2.38; 95% CI, 1.4-4.02); and discomfort when the bladder was full (23% vs. 4.9%; crude OR = 5.79; 95% CI, 3.82-8.78; aOR = 6.04; 95% CI, 3.74-9.76). Among those with endometriosis, the odds of lower urinary tract symptoms did not change regardless of the stage of disease, defined by the revised American Society for Reproductive Medicine classification, or the length of time a woman experienced endometriosis-associated symptoms.

According to Gabriel and colleagues, limitations to the study include the possibility that a patient’s lower urinary tract symptoms or stage of endometriosis were incorrectly described. However, they also said such limitations would likely underestimate the associations instead of overestimate them.

“We propose that lower urinary tract symptoms should be concurrently addressed during the course of initial diagnosis and subsequent management of endometriosis,” the researchers wrote.

References:

Fuldeore MJ, Soliman AM. Gynecol Obstet Invest. 2017;doi:10.1159/000452660.

Gabriel I, et al. Fertil Steril. 2022;doi:10.1016/j.fertnstert.2022.01.003.

WHO. Endometriosis. https://www.who.int/news-room/fact-sheets/detail/endometriosis. Published March 31, 2021. Accessed Feb. 17, 2022.