Endometriosis: a high-risk population for major chronic diseases?

Kvaskoff, Marina; Mu, Fan; Terry, Kathryn L.; Harris, Holly R.; Poole, Elizabeth M.; Farland, Leslie V.; Missmer, Stacey A.

doi:10.1093/humupd/dmv013

Cited by 297 publications

(248 citation statements)

References 96 publications

(134 reference statements)

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“…Endometriosis also seems to elevate an individual's cardiovascular risk [16]. Findings of the above studies show that counseling and awareness of overall metabolic health risks are necessary when dealing with the PCOS and endometriosis populations.…”

Section: Metabolic Dysfunction and Cardiovascular Diseasementioning

confidence: 93%

“…These subgroups included women with unexplained infertility, parous women with only one delivery as opposed to multiple deliveries following reproductive technology, women with PCOS, and women who had used progesterone therapy as part of their fertility treatment [8,10,15,19]. In a meta-analysis of 21 studies by Kvaskoff et al, 20 studies showed an elevated ovarian cancer risk in women with endometriosis, while one study failed to show this association [16]. Evaluating women with a general diagnosis of infertility appears to yield conflicting results, but certain subgroups of infertile women may benefit from additional testing or counseling related to the topic of ovarian cancer.…”

Section: Ovarian Cancermentioning

confidence: 99%

“…The eight studies detailed in Table 5 show correlations between infertility and increased cardiovascular risk, higher myocardial infarction rates, higher insulin resistance, increased waist circumference, higher rates of central adiposity, increased diagnosis of metabolic syndrome, and increased risk of non-alcoholic fatty liver disease [16,[21][22][23][24][25][26]. These studies also show increased hospitalizations for various disease processes in women with a known history of PCOS [6].…”

Section: Metabolic Dysfunction and Cardiovascular Diseasementioning

confidence: 99%

“…A possible increased risk of gynecologic malignancies in infertile women has been proposed in multiple studies [10,[32][33][34][35][36]. Furthermore, endometriosis has been related to higher rates of melanoma, asthma, autoimmune disease, atopic disease, cardiovascular disease, and ovarian cancer [16]. PCOS has been linked with increased waist circumference, insulin resistance, elevated serum insulin levels, higher lipoprotein ratios, type II diabetes, hyperlipidemia, and increases in central/visceral adiposity even in the setting of normal BMI [6,22].…”

Section: Introductionmentioning

confidence: 99%

“…An analysis of publications shows that women with infertility had higher rates of psychiatric disorders and endometrial cancer than the general population [1][2][3][4][5][6][7][8][9][10]. Data is conflicting about whether infertile women are at increased risk for breast cancer and ovarian cancer [7,8,[10][11][12][13][14][15][16][17][18][19][20]. A generalized diagnosis of infertility was not clearly associated with an increased risk of cardiovascular disease or metabolic dysfunction, but women with infertility related to polycystic ovarian syndrome (PCOS) do appear more likely to develop cardioCapsule There is a growing body of literature addressing the impact of female infertility on long-term health.…”

mentioning

confidence: 99%

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Female infertility, infertility-associated diagnoses, and comorbidities: a review

Hanson

Johnstone

Dorais

et al. 2016

J Assist Reprod Genet

205

145

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Purpose The purpose of the study is to evaluate existing literature for possible associations between female infertility, infertility-associated diagnoses, and the following areas of disease: psychiatric disorders, breast cancer, ovarian cancer, endometrial cancer, cardiovascular disease, and metabolic dysfunction. Methods The design of the study is a literature review. The patients were women included in 26 selected studies due to a diagnosis of infertility or a reproductive disorder associated with infertility. This study has no interventions, and the main outcome measure is the association between female infertility or a related diagnosis and psychiatric disorders, breast cancer, ovarian cancer, endometrial cancer, cardiovascular disease, and metabolic dysfunction. Results Female infertility and related reproductive disorders may have ramifications for women beyond reproductive health. An analysis of publications shows that women with infertility had higher rates of psychiatric disorders and endometrial cancer than the general population [1][2][3][4][5][6][7][8][9][10]. Data is conflicting about whether infertile women are at increased risk for breast cancer and ovarian cancer [7,8,[10][11][12][13][14][15][16][17][18][19][20]. A generalized diagnosis of infertility was not clearly associated with an increased risk of cardiovascular disease or metabolic dysfunction, but women with infertility related to polycystic ovarian syndrome (PCOS) do appear more likely to develop cardioCapsule There is a growing body of literature addressing the impact of female infertility on long-term health. This review evaluates 26 studies, investigating possible correlations between infertility and psychiatric illness, breast cancer, ovarian cancer, endometrial cancer, cardiovascular disease, and metabolic dysfunction. Overall, higher rates of psychiatric illness and endometrial cancer were seen in infertile women. It is unclear whether infertility results in increased rates of breast cancer and ovarian cancer, and data are conflicting regarding correlations between generalized infertility and cardiovascular disease and metabolic dysfunction. This study summarizes current literature and can guide practitioners in counseling infertile patients.

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Section: Metabolic Dysfunction and Cardiovascular Diseasementioning

confidence: 93%

Section: Ovarian Cancermentioning

confidence: 99%

Section: Metabolic Dysfunction and Cardiovascular Diseasementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Female infertility, infertility-associated diagnoses, and comorbidities: a review

Hanson

Johnstone

Dorais

et al. 2016

J Assist Reprod Genet

205

145

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Association Between Laparoscopically Confirmed Endometriosis and Risk of Early Natural Menopause

et al. 2022

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IMPORTANCEEarly natural menopause (ENM) has been associated with reduced reproductive span, cardiovascular disease risk, and early mortality. The potential adverse implications of endometrioma surgery for ovarian reserve are known, yet the association of endometriosis with menopausal timing remains understudied. OBJECTIVE To investigate the association between endometriosis and risk for ENM. DESIGN, SETTING, AND PARTICIPANTS This large, population-based cohort study analyzed data from the Nurses' Health Study II cohort questionnaires from the 1989 to 2015 questionnaire cycles. The sample included premenopausal women aged 25 to 42 years at baseline or enrollment in 1989. Cumulative follow-up rate was greater than 90%, and participants continued follow-up until the onset of ENM, age 45 years, hysterectomy, oophorectomy, cancer diagnosis, death, loss to follow-up, or end of follow-up in May 2017, whichever occurred first. Data analyses were conducted from October 26, 2020, to April 27, 2021. EXPOSURES Endometriosis diagnosis status was queried in the biennial questionnaires, with participants reporting physician diagnosis and whether the diagnosis was laparoscopically confirmed. MAIN OUTCOMES AND MEASURES Natural menopause before age 45 years. Menopause status was assessed every 2 years. RESULTSThe study included 106 633 premenopausal women with a mean (SD) age of 34.8 (4.3) years at baseline, of whom 3921 reported a laparoscopically confirmed endometriosis diagnosis.During 1 508 462 person-years of follow-up, 6640 participants reported being diagnosed with endometriosis, 99 993 never reported endometriosis, and 2542 reported experiencing ENM. In the age-and calendar time-adjusted model, laparoscopically confirmed endometriosis was associated with a 50% greater risk for ENM (hazard ratio [HR], 1.51; 95% CI, 1.30-1.74). A similar risk was observed after adjusting for race and ethnicity and time-varying anthropometric and behavioral factors (HR, 1.46; 95% CI, 1.26-1.69). With additional adjustment for reproductive factors, the HR of ENM was attenuated but significant (HR, 1.28; 95% CI, 1.10-1.48). A greater risk of ENM was observed among women who were nulliparous after stratifying by parity (nulliparous vs parous: HR, 1.46 [95% CI, 1.15-1.86] vs 1.14 [95% CI, 0.94-1.39]; P for heterogeneity = .05) or who never used oral contraceptives when stratifying by oral contraceptive use (never vs ever: HR, 2.03 [95% CI, 1.34-3.06] vs 1.20 [95% CI, 1.02-1.42]; P for heterogeneity = .02). No significant differences were observed in the association between endometriosis and ENM when stratifying by body mass index (calculated as weight in kilograms divided by height in meters squared; <25 vs Ն25: HR, 1.20 [95% CI, 0.99-1.45] vs 1.43 [95% CI, 1.11-1.83; P for heterogeneity = .34), cigarette smoking status (never vs (continued) Key Points Question Is there an association between endometriosis and early natural menopause? Findings In this cohort study of 106 633 premenopausal women, a statistically significant association was found b...

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Good News About Endometriosis and Preterm Delivery

Saavalainen

Heikinheimo

2022

JAMA Netw Open

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Endometriosis is a common inflammatory disease of the female pelvis; typical symptoms include pelvic pain and subfertility. Endometriosis is often divided into subtypes of peritoneal, ovarian, and deep infiltrating endometriosis. Classically (ie, surgically) diagnosed endometriosis has been associated with increased risk for ovarian cancer, cardiovascular disease, and some autoimmune diseases 1 . In addition, endometriosis has emerged as a risk factor for various adverse pregnancy outcomes, such as cesarean delivery, placenta previa, and postpartum bleeding. 2 Several studies have suggested that women with endometriosis have a slightly increased risk for preterm birth. 2 The cause seems to be related to factors associated with pathogenesis of endometriosis, such as inflammation, reactive oxygen species, progesterone resistance, and alterations in the junctional zone of uterus leading to the shallow invasion of the placenta and to preterm birth. 3,4 Other endometriosis-associated obstetric risks, such as hypertension and preeclampsia, placenta previa, intrauterine growth retardation, and gestational diabetes, might also relate to the increased risk for preterm birth. However, these studies were mostly retrospective, had differing processes for classification of endometriosis and selection of patients, and typically included predominantly women with subfertility. The possible concomitant adenomyosis is an important confounding factor for which these studies rarely adjusted. 2,5 In addition, the follow-up and management of pregnancy and delivery varied nationally and regionally.

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Endometriosis: a high-risk population for major chronic diseases?

Cited by 297 publications

References 96 publications

Female infertility, infertility-associated diagnoses, and comorbidities: a review

Female infertility, infertility-associated diagnoses, and comorbidities: a review

Association Between Laparoscopically Confirmed Endometriosis and Risk of Early Natural Menopause

Good News About Endometriosis and Preterm Delivery

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