Endometriosis and the enigmatic question of progression

Aims: The aim of this study was to identify whether endometriosis is a progressive disease with age, and to review the literature on this topic. Material and methods: The incidence of endometriosis in a cohort of 500 women who underwent laparoscopy between 2003 and 2013 in the Greenville Health System, in South Carolina, United States, was reviewed. The search of the world literature on progression of endometriosis was limited to 1980 and beyond. Results: The correlation between stage of endometriosis and age was found to be small (r = -0.04; 95% CI, -0.13 to 0.04; p = 0.3; n = 471). The literature search identified 16 studies on adults. Progression of endometriosis findings at laparoscopy occurred in 31% of the cases with follow-up (n = 162). Conclusions: Endometriosis of minimal or mild American Society for Reproductive Medicine (rASRM) classification stage is equally likely to be present in women of all ages; similarly, endometriosis in its severe form is not age-dependent.