title: Strong Association Between Endometriosis and Symptomatic Leiomyomas.
abstract: OBJECTIVE
  The relationship between leiomyoma and endometriosis is poorly understood. Both contribute to considerable pain and may cause subfertility or infertility in women. We conducted this retrospective study to assess the rate of coexistence of endometriosis in women with symptomatic leiomyoma. The primary outcome measured was the coexistence of histology-proven endometriosis in women with symptomatic leiomyoma.
  
  
  METHODS
  This is a retrospective review of a data-based collection of medical records of 244 patients treated at a tertiary medical center, who were evaluated for symptomatic leiomyoma from March 2011 through December 2015. Of those, 208 patients underwent laparoscopic or laparoscopic-assisted myomectomy or hysterectomy. All patients provided consent for possible concomitant diagnosis and treatment of endometriosis. The remaining 36 patients underwent medical therapy and were excluded from the study. All patients who had myomectomy or supracervical hysterectomy underwent minilaparotomy for extracorporeal morcellation and specimen removal beginning in April 2012.
  
  
  RESULTS
  Of the 208 patients with the presenting chief concern of symptomatic leiomyoma and who underwent surgical therapy, 181 had concomitant diagnoses of leiomyoma and endometriosis, whereas 27 had leiomyoma. Of the 27 patients, 9 also had adenomyosis. Patients with only fibroid tumors were, on average, 4.0 years older than those with endometriosis and fibroids (mean age, 44 vs 40 ± SD). Patients with both pathologies were also more likely to present with pelvic pain and nulliparity than those with fibroid tumors alone.
  
  
  CONCLUSIONS
  In our patient population, 87.1% of patients with a chief concern of symptomatic fibroids also had a diagnosis of histology-proven endometriosis, which affirms the need for concomitant diagnosis and intraoperative treatment of both conditions. Overlooking the coexistence of endometriosis in women with symptomatic leiomyoma may lead to suboptimal treatment of fertility and persistent pelvic pain. It is important for physicians to be aware of the possibility of this association and to thoroughly evaluate the abdomen and pelvis for endometriosis at the time of myomectomy or hysterectomy in an effort to avoid the need for reoperation.
authors.affiliation: Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA.
authors.forename: Camran
authors.initials: C
authors.lastname: Nezhat
authors.affiliation: Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA.
authors.forename: Anjie
authors.initials: A
authors.lastname: Li
authors.affiliation: Sinai Hospital, Baltimore, Maryland, USA.
authors.forename: Sozdar
authors.initials: S
authors.lastname: Abed
authors.affiliation: Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Balassiano
authors.affiliation: Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA.
authors.forename: Rose
authors.initials: R
authors.lastname: Soliemannjad
authors.affiliation: Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California, USA.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Nezhat
authors.affiliation: Nezhat Medical Center, Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia, USA.
authors.forename: Ceana H
authors.initials: CH
authors.lastname: Nezhat
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: Farr
authors.initials: F
authors.lastname: Nezhat
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D015994:Incidence; D010535:Laparoscopy; D007889:Leiomyoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D063186:Uterine Myomectomy / Q000379:methods; D014594:Uterine Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery
keywords: Adenomyosis; Laparoscopy-assisted myomectomy; Minimally invasive surgery; Morcellation; Robotic surgery