title: Characteristics of women with endometriosis from the USA and Puerto Rico.
abstract: OBJECTIVE
  To describe lifetime differences in clinical characteristics of women with endometriosis between the USA and Puerto Rico.
  
  
  METHODS
  A descriptive study using self-administered demographic and clinical questionnaires was undertaken. Women with self-reported surgically diagnosed endometriosis who completed questionnaires from the Endometriosis Association (EA), Wisconsin, USA (n = 4358) and the Endometriosis Research Program (ERP) in Puerto Rico (n = 878), were included in this study. We compared demographic, gynecological and clinical history, frequency of endometriosis-associated symptoms and co-morbidities.
  
  
  RESULTS
  Although both groups have similar symptomatology, EA respondents had significantly higher rates of chronic pelvic pain and incapacitating pain than ERP participants. EA respondents were significantly more likely to report a history of problems getting pregnant, heavy bleeding, and hysterectomy than ERP respondents. Miscarriages were more frequently reported by the ERP group. Co-morbidities such as allergies, chronic fatigue syndrome, and fibromyalgia were more prevalent in EA respondents, whereas asthma was significantly more frequent in participants from ERP.
  
  
  CONCLUSIONS
  Overall, women with endometriosis from the USA and Puerto Rico reported high rates of pain and infertility and a similar spectrum of symptoms. Those from the EA reported longer time to diagnosis, and diagnostic delays than those from the ERP, which may explain the observed increased in rates of endometriosis-related symptoms and co-morbidities in EA as compared to ERP.
authors.affiliation: Public Health Program, Ponce Health Sciences University, Ponce - Puerto Rico.
authors.forename: Jessica
authors.initials: J
authors.lastname: Fourquet
authors.affiliation: Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland - USA.
authors.forename: Ninet
authors.initials: N
authors.lastname: Sinaii
authors.affiliation: Program in Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, NIH, Bethesda, Maryland - USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Stratton
authors.affiliation: Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland - USA.
authors.forename: Fareed
authors.initials: F
authors.lastname: Khayel
authors.affiliation: Public Health Program, Ponce Health Sciences University, Ponce - Puerto Rico.
authors.forename: Carolina
authors.initials: C
authors.lastname: Alvarez-Garriga
authors.affiliation: Public Health Program, Ponce Health Sciences University, Ponce - Puerto Rico.
authors.forename: Manuel
authors.initials: M
authors.lastname: Bayona
authors.affiliation: Endometriosis Association, Milwaukee, Wisconsin - USA.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Ballweg
authors.affiliation: Department of Microbiology, Department of Obstetrics and Gynecology, Ponce Health Sciences University, Ponce - Puerto Rico.
authors.forename: Idhaliz
authors.initials: I
authors.lastname: Flores
keywords: Co-morbidity; Disparities; Endometriosis; Epidemiology; Infertility; Pain