Limited differences in the incidence of endometriosis and adenomyosis in Black versus White women with pelvic pain

Several studies have suggested that endometriosis occurs more commonly in White women than Black women. However, there are limited data that suggest that the incidence of endometriosis may not be different between the two groups. The objective of this study was to compare the incidence of endometriosis and/or adenomyosis between Black and White women. A retrospective cohort study of all Black and White women presenting to an academic gynecologic (minimally invasive and urogynecologic) practice between January 1st 2017 and January 1st 2021 with an ICD10 diagnosis of pelvic and perineal pain. An assessment of which patients proceeded to laparoscopic or open surgery for pain during that time frame, and the surgical and pathologic findings were assessed to determine the incidence of endometriosis, adenomyosis or myomas in each racial group. An odd’s ratio to assess the likelihood of proceeding to surgery was calculated. The incidence of these conditions was compared between Black and White women using Pearson’s chi squared or Fisher’s exact test where appropriate. P values less than 0.5 were considered significant. IRB 21-0508. 573 Black patients and 569 White patients were seen for consultation for pelvic pain. Seventy-eight women proceeded to have laparoscopic or open surgery where at least one of the indications for surgery by ICD 10 code was for pelvic pain. Sixty-eight percent of the patients were White (n=53) and 32 % of patients were Black (n=25). Among these women, 30 had also had an ICD 10 code for leiomyomas. Black women were less likely to proceed with surgery for pelvic pain than White women, OR 0.44 (95% CI 0.27 to 0.72) p<0.01. There was a higher incidence of endometriosis among White women (69.8% n=37) who had surgery for pelvic pain compared to Black women (16% n=4) p< 0.01. There continued to be a difference in the incidence of endometriosis or adenomyosis among White (71.6% n= 38) compared to Black women (36% n=9) p<0.01. Black women in this cohort also had a higher incidence of uterine myomas compared to White women (72% n= 18 vs. 22.6% n = 12) p < 0.01. Sixty women had a preoperative diagnosis of pelvic pain without a coincident diagnosis of fibroids (Black n=13 White =47). When comparing the incidence of endometriosis in this cohort, White women (76.6% n=36) continued to have a higher incidence of endometriosis than Black women (30.8% n=4) p=0.01. However, when comparing the incidence of endometriosis or adenomyosis between White women (78.7% n= 37) and Black women (53.8% n= 7) there was no significant difference between the two groups p=0.09. Black women are less likely than White women to have surgery to address pelvic pain. When Black women do have surgery for pelvic pain, fibroids are likely part of the diagnosis. However, when fibroids are not suspected, Black and White women may have a similar incidence of endometriosis/adenomyosis.