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PIH2 – Comorbidities and Symptoms among Endometriosis Patients: A Systematic Literature Review

AM Soliman, H Yang, EX Du, EQ Wu, J Castelli-Haley, C Winkel



Endometriosis patients could experience a myriad of comorbidities. This study aimed to systematically review comorbidities and symptoms reported by endometriosis patients in the medical literature.


MEDLINE and EMBASE databases were searched for articles reporting comorbidities and/or symptoms among endometriosis patients published in English between 2000 and 2013. The following search terms were used in the search process: “endometriosis, or endometrioses, or endometrioma$ ($ for truncation) or endometrial lesion$” and “comorbid$ or risk factor$ or multimorbid$”.


Thirty-nine articles met study criteria and were reviewed. Study populations included women with clinically or surgically diagnosed endometriosis, women undergoing laparoscopy for endometriosis and women self-reporting endometriosis. Twenty-two of the 39 studies included control groups. Higher rates of depression/anxiety disorders (6.5%-51.4%), migraine (4.7%-78.8%), chronic fatigue (0.3%-6%) and digestive diseases like irritable bowel syndrome, ulcerative colitis and dyschezia were reported among endometriosis patients. Endometriosis patients experienced higher rates of infectious diseases, pelvic inflammation disease, multiple sclerosis, lupus and fibromyalgia compared to controls as well. Endometriosis patients also reported higher rates of ovarian, breast, endometrium and cervix cancers but differences between endometriosis and controls were not significant in all studies. Rates of uterine fibroids were 16.1% to 50.7% but results were mixed when comparing those rates between endometriosis patients and controls. Thirteen studies reported fertility or pregnancy-related comorbidities. Infertility rates varied from 1.3% to 63.6%; most studies observed higher infertility rates in women with endometriosis than in controls. Rates of pre-eclampsia, cesarean section, induced and spontaneous preterm birth and spontaneous abortion were also higher among women with endometriosis. Pelvic, abdominal, ovarian and lumbar pain were among the most commonly reported symptoms among Endometriosis patients.


Endometriosis patients reported higher frequency of gynecologic and non-gynecologic comorbidities and symptoms. Economic burden of comorbidities and mechanisms that link them to endometriosis remain to be examined.

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About the Editors

  • Prof Timothy Vartanian

    Timothy Vartanian, Professor at the Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, Cornell...
  • Dr Claire S. Riley

    Claire S. Riley, MD is an assistant attending neurologist and assistant professor of neurology in the Neurological Institute, Columbia University,...
  • Dr Rebecca Farber

    Rebecca Farber, MD is an attending neurologist and assistant professor of neurology at the Neurological Institute, Columbia University, in New...

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