Challenging prior assumptions: coexistence of polycystic ovarian morphology and endometriosis on transvaginal ultrasound.
Level 4 - case-series / case-control
Retrospective single-center cross-sectional observational cohort study.
PubMed 42536999 · doi:10.1002/uog.70289
What was done
A retrospective cohort study evaluated 165 consecutive patients undergoing advanced transvaginal ultrasound for suspected or previously diagnosed endometriosis at a tertiary gynecological ultrasound clinic between February and June 2023. Sonographic endometriosis was classified as superficial, ovarian, or deep based on International Deep Endometriosis Analysis consensus criteria. Polycystic ovarian morphology (PCOM) was defined by guideline criteria (≥20 follicles measuring 2–9 mm and/or ovarian volume >10 mL). Researchers compared demographic and clinical variables between patients with endometriosis alone versus concurrent endometriosis and PCOM, performed logistic regression adjusted for age and BMI, and conducted an age-restricted (25–35 years) sensitivity analysis.
What was found
Among 165 patients, 62.4% (n = 103) had endometriosis, 37.0% (n = 61) had PCOM, and 35.0% (36/103) of patients with endometriosis had concurrent PCOM. Deep endometriosis was significantly less frequent among those with PCOM, while superficial and ovarian endometriosis frequencies did not differ significantly. Patients with concurrent endometriosis and PCOM were younger, had lower body weight, and had higher proportions of nulligravidae and nulliparae. In multivariable logistic regression among endometriosis patients, increasing age was associated with lower odds of concurrent PCOM (adjusted OR 0.84, 95% CI 0.77–0.92 per 1-year increase; P < 0.001), whereas BMI had no independent association (adjusted OR 0.99, 95% CI 0.91–1.09; P = 0.874). In the age-restricted sensitivity analysis (25–35 years), differences in endometriosis phenotypes and demographic variables were no longer statistically significant.
Why it matters
Sonographic PCOM and endometriosis frequently coexist in tertiary referral patients, but observed phenotypic differences appear predominantly driven by age rather than distinct underlying disease interactions.
Limits
Key limitations include the retrospective, single-center design and modest sample size (n = 165). The cohort was restricted to tertiary clinic patients with suspected endometriosis, introducing referral bias. The study evaluated sonographic morphology (PCOM) rather than clinical polycystic ovary syndrome (PCOS), and lacked endocrine profiling, standardized cycle-phase assessment, side-specific ovarian tracking, and laparoscopic or histological confirmation.
Cited by
- contradicts More than 50% of PCOS patients also have endometriosis.