Prevalence of Common Gynecological Conditions in the Middle East: Systematic Review and Meta-Analysis

Abstract

Introduction: High prevalence of gynecological conditions in women of Middle Eastern origin is reported, likely due to regional risk factors and mediators. The objective of this systematic review and meta-analysis is to investigate the prevalence of polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, and adenomyosis in women of Middle Eastern origin.Methods: MEDLINE, EMBASE, PsycINFO, Global Health, and Google Scholar databases were searched from database inception until 14 February 2021 to identify relevant studies. Peer-reviewed research articles that reported the prevalence of PCOS, endometriosis, uterine fibroids, and adenomyosis in the Middle Eastern population were written in English or Arabic. The primary outcome was the estimated pooled prevalence of PCOS, endometriosis, uterine fibroids, and adenomyosis in the Middle Eastern populations. The secondary outcome was to assess the evidence in the data for the presence of heterogeneity, by conducting subtype-pooled analysis of prevalence estimates of the conditions. Total weighted prevalence was calculated via Freeman–Tukey arcsine transformation and heterogeneity through the I2 statistic. Quality control was performed using GRADE criteria.Results: A total of 47 studies, 26 on PCOS, 12 on endometriosis, eight on uterine fibroids, and seven on adenomyosis, were included. The pooled prevalence of PCOS diagnosed according to the NIH criteria was 8.9% (95% CI: 6.5–11.7; prevalence range: 4.0–27.6%), with a higher prevalence from the Gulf Arab states (18.8%, 95% CI: 9.5–30.3; range: 12.1–27.6%). According to the Rotterdam criteria, the pooled prevalence of PCOS was 11.9% (95% CI: 7.1–17.7; range: 3.4–19.9%) with studies limited to the Persian and Levant regions. Endometriosis was diagnosed in 12.9% (95% CI: 4.2–25.4; range: 4.2–21.0%) of women undergoing laparoscopy, for any indication. Uterine fibroid and adenomyosis prevalence of women was 30.6% (95% CI: 24.9–36.7; range: 18.5–42.6%) and 30.8% (95% CI: 27.1–34.6, range: 25.6–37.7%), respectively. Heterogeneity was present between studies due to statistical and methodological inconsistencies between studies, and quality of evidence was low due to sample size and unrepresentative participant selection.Conclusion: This is the first review that has reported the prevalence of gynecological diseases in the Middle Eastern population, suggesting that gynecological morbidity is a public health concern. Due to the health disparities in women, further research is required to understand the relative roles of environmental and genetic factors in the region to serve as a benchmark for evaluation and comparative purposes with other populations.

The association between endometriosis and risk of endometrial cancer and breast cancer: a meta-analysis

“…Because the current diagnosis of EMS requires surgical visualization and the confirmation of pathological results [3], the measurement of the incidence and prevalence of endometriosis is complicated, and estimates vary widely among different studies. Based on the prevalence of pelvic pain and infertility in the general population, the estimated population prevalence of endometriosis is approximately 10% [4,5] and is higher in symptomatic women [6].…”

“…Fig 6. Funnel plot using data from the 16 studies evaluating the association between endometriosis and breast cancer…”

Impact of Endometriosis in Women of Arab Ancestry on: Health-Related Quality of Life, Work Productivity, and Diagnostic Delay

“…In a systematic review with meta-analysis, the pooled prevalence of endometriosis was estimated to be 12.9% (95% CI: 4.2-25.4) in Middle Eastern women undergoing laparoscopy, for any indication (13). While the findings of this review demonstrated that the region lacks reliable, population-based data on the symptomatology and risk factors of endometriosis, there are inherent difficulties in the universal application of symptom and phenotype-based criteria across different countries and cultures, as demonstrated for polycystic ovary syndrome among Arab women (13)(14)(15)(16)(17). No studies have assessed the diagnostic delay, work productivity or activity impairment among Middle Eastern women with endometriosis.…”

The Impact of Irregular Menstruation on Health: A Review of the Literature

“…Studies on gynecological conditions are underrepresented in low- and middle-income Middle Eastern countries affected by war and political instability, such as Iraq, Syria, Libya, Sudan, Lebanon, Yemen, and Palestine, unlike in higher-income countries like the Gulf countries, Turkey, and Egypt, where women have greater access to healthcare and may be more thoroughly screened [ 30 ]. In these conflict-affected areas, young women may suffer from chronic pain and menstrual irregularities, but cultural norms may prevent them from seeking help, prolonging their suffering [ 30 ].…”