Demographic and hematological differences between endometriosis and menorrhagia in Saudi women: A retrospective observational study of 946 patients

Endometriosis and menorrhagia are prevalent gynecological conditions with overlapping symptoms, yet comparative data from Middle Eastern populations remain scarce. We aimed to comprehensively characterize demographic and hematological differences between these conditions in Saudi women, where obesity prevalence reaches 44%. This observational study analyzed 946 women (351 with surgically-confirmed endometriosis, 595 with menorrhagia) at King Khalid Medical City, Riyadh (January 2020-December 2024). Demographic, anthropometric, and hematological parameters were compared using chi-square tests for categorical variables and independent t-tests for continuous variables. The study followed Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (see Table, Supplemental Digital Content 1, Supplemental Digital Content, https://links.lww.com/MD/R574). Women with endometriosis were younger (65.2% < 40 years vs 39.0%, odds ratio [OR] = 2.94, 95% confidence interval [CI]: 2.26-3.84, P < .0001) and had lower obesity prevalence (27.5% vs 49.1%, OR = 2.55, 95% CI: 1.84-3.53, P < .0001) compared to menorrhagia patients. A characteristic iron deficiency pattern emerged in menorrhagia: elevated red cell distribution width (56.6% vs 41.0%, OR = 1.88, 95% CI: 1.42-2.48, P < .0001), microcytosis (41.9% vs 31.9%, OR = 1.54, 95% CI: 1.16-2.04, P = .003), anemia (46.4% vs 35.6%, OR = 1.57, 95% CI: 1.18-2.10, P = .004), and low hematocrit (50.3% vs 39.3%, OR = 1.56, 95% CI: 1.19-2.05, P = .001). Mean platelet volume elevation was more common in endometriosis (8.8% vs 3.4%, OR = 2.78, 95% CI: 1.56-4.95, P < .001). This observational study reveals distinct demographic and hematological profiles between surgically-confirmed endometriosis and menorrhagia in Saudi women. The prominent iron deficiency pattern in menorrhagia emphasizes the importance of systematic iron status evaluation. These findings provide essential baseline data for understanding these conditions in Middle Eastern populations.