Familial risk for endometriosis and its interaction with smoking, age at menarche and body mass index: a population‐based cohort study among siblings

Abstract

Objective To quantify familial risk of endometriosis among full siblings and examine interactions between family history and smoking, age at menarche or body mass index (BMI).Design, setting and population Population-based nationwide cohort study.Methods Using data from the Korean National Health Insurance and Screening Programme databases on kinship, healthcare utilisation, lifestyle and anthropometrics, we identified 2 109 288 women with full siblings and their environmental risk factors from 2002 to 2018. Familial risks were estimated using Cox proportional-hazards models, represented as incidence risk ratios (IRR) with 95% CI. Interaction between family history and smoking, age at menarche or BMI were assessed on an additive scale.Main outcome measures IRR of endometriosis among women with and without affected siblings.Results From 19 195 women with affected siblings, 1126 developed endometriosis with an incidence of 35.45/10 000 person-years. Familial risk of endometriosis with versus without affected siblings was increased to IRR 2.75 (95% CI 2.25-3.36), and the highest risk was with affected twins (IRR 6.98;. Women with both a family history and either smoking, early menarche or low BMI had a significantly higher risk of endometriosis compared with the general population and can be regarded as a high-risk group, the IRRs were 4.28 (95% CI 2.43-7.55), 3.47 (95% CI 2.82-4.26) and 3.09 (95% CI 2.68-3.56), respectively. Substantial effect modification of the associations was noted by smoking and early menarche, as their combined risk with family history exceeded the sum of their individual risks, which was also statistically significant.Conclusion Genetic factors are the primary contributor to the familial aggregation of endometriosis. Significant geneenvironment interaction exists between family history and smoking or early menarche.

Height and pelvic lesion number: Do they have a positive relationship with postoperative recurrence in adolescent endometriosis?—A retrospective clinical analysis of 89 adolescent endometriosis in China

“…It may can used to explain the reason of taller figure in EMs patients. However, in present literature, early menarche age is thought to be the risk factor of EMs 30 . Among the risk factors of EMs, tall height and earlier menstrual age seem to be a pair of contradictory factors.…”

“…However, in present literature, early menarche age is thought to be the risk factor of EMs. 30 Among the risk factors of EMs, tall height and earlier menstrual age seem to be a pair of contradictory factors. Adult height is influenced by menstrual age but also many other factors, such as childhood nutritional status, genetics, and environment.…”

Body mass index and endometriosis: Is there a relationship?

“…To date, several retrospective and prospective studies have investigated the relationship between body weight and BMI in endometriotic patients in comparison to non-endometriotic women, which have shown inconsistent results. 10,[12][13][14][15][16][17][18][19] For example, Hemmings et al 13 , Ashrafi et al, 20 and Saha et al 16 have shown no significant association between BMI and EM in their case-control and cross-sectional studies. In contrast, Ferrero et al 10 , Shahbazi and Shahrabi-Farahani, 2 and Kim et al 17 have reported a significant inverse correlation between BMI and EM.…”

“…10,[12][13][14][15][16][17][18][19] For example, Hemmings et al 13 , Ashrafi et al, 20 and Saha et al 16 have shown no significant association between BMI and EM in their case-control and cross-sectional studies. In contrast, Ferrero et al 10 , Shahbazi and Shahrabi-Farahani, 2 and Kim et al 17 have reported a significant inverse correlation between BMI and EM. The meta-analysis on two cohorts and nine casecontrol studies reported that a higher body mass index is associated with a lower risk of EM.…”

Uncovering Evidence: Associations between Environmental Contaminants and Disparities in Women’s Health

“…Thus, as a consequence of CYP19 gene variants, Black women may exhibit heightened expression of aromatase following environmental exposures. Although several studies have explored gene-environment interactions in the risk of endometriosis [104,105], to our knowledge, these have not included a discussion on racial differences. Hence, women of color may have genotypes and phenotypes that make them susceptible to endometriosis, but misconceptions regarding risk combined with years of deficits in diagnostic measures may contribute to the reduced identification of disease among this group.…”