Endometriosis is common in China. No figures but pelvic pain is the commonest reason for women to attend the gynaecological clinic. BUT it’s distribution is entirely different from that in the UK.
As a consequence of the “one-child policy” many Chinese women have three surgical terminations of pregnancy before their single child – that is born by Caesarean section (CS rate is 60-70%). In the UK the surgical TOP rate is around 40% though rates of multiple surgical TOPs are much lower. There is more use of medical termination of pregnancy using drugs. Women then have one or more vaginal deliveries.
Chinese women frequently have small deposits of endometriosis over their uterosacral ligaments (that hold the uterus in place) following a less-than-gentle, surgical TOP (the surgeon may pull on the cervix more than is necessary – this injures the uterosacral ligaments that hold the cervix and uterus in place). There is little, stage IV endometriosis – that follows persistent straining during defaecation. (one colleague at a teaching centre has found one such case in the past 12 months). Women in the UK demonstrate greater damage of their uterine ligaments (consistent with difficult vaginal deliveries) and a wider distribution of deposits of endometriosis (over areas of pelvic injury arising from vaginal delivery). The differences between the two populations are striking; the results are equally disappointing in terms of overall relief of pain – which results from underlying injured nerves rather than visible spots of endometriosis.