Uterine leiomyoma is associated with the risk of developing endometriosis: A nationwide cohort study involving 156,195 women

Abstract

Objective Evidence for an association between uterine leiomyoma and increased risk of endometriosis is limited by small sample sizes and short follow-up periods. We assessed this association in a large nationwide sample with 14 years of data. Design Data were sourced from Taiwan’s Longitudinal Health Insurance Database 2000 (LHID2000). Materials and methods We identified 31,239 women aged ≥20 years diagnosed with uterine leiomyoma (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] code 218) between Jan 1, 2000 and Dec 31, 2012, who were matched with 124,956 controls (1:4) by 5-year age groups and year of diagnosis. Follow-up was from the date of LHID2000 entry to the first occurrence of endometriosis, loss to follow-up, insurance termination, or until December 31, 2013, whichever was earlier. Results In Cox regression analysis, the adjusted hazard ratio (aHR) for endometriosis in women with uterine leiomyoma was 6.44 (95% CI, 6.18, 6.72) compared with controls. The risk of endometriosis was significantly increased in women with uterine leiomyoma and comorbidities of tube-ovarian infection (aHR 2.86; 95% CI, 1.28, 6.36), endometritis (1.14; 1.06, 1.24), infertility (1.26; 1.16, 1.37), or allergic diseases (1.11; 1.05, 1.17). Having both uterine leiomyoma and endometritis significantly increased the risk of endometriosis (aHR 6.73; 95% CI, 6.07, 7.45) versus having only uterine leiomyoma (6.61; 6.33, 6.91) or endometritis (1.49; 1.31, 1.69). Similarly, having both uterine leiomyoma and infertility significantly increased the risk of endometriosis (aHR 6.95; 95% CI, 6.21, 7.78) versus having only uterine leiomyoma (6.66; 6.38, 6.96) or infertility (1.78; 1.57, 2.02). Conclusions A diagnosis of uterine leiomyoma appears to increase the risk of endometriosis. Patients presenting with uterine fibroids should be encouraged to give informed consent for possible simultaneous surgical treatment of endometriosis.

Successful Laparoscopic-Assisted Supracervical Hysterectomy in a 14-Week-Sized Fibroid Uterus: An Autobiographical Case Report

“…Dysfunctional uterine bleeding and pelvic pain can be of multifactorial origin, and both conditions share multiple features [14]. A 2021 Taiwanese study, using 14 years of data and over 150,000 women, revealed a statistically significant association in patients with uterine leiomyoma developing endometriosis (adjusted hazard ratio: 6.44) [15]. This and similar, smaller studies highlight an opportunity to increase awareness.…”

Endometriosis and Uterine Fibroids (Leiomyomata): Comorbidity, Risks and Implications

“…Interestingly, a diagnosis of adenomyosis, where it was included in the analysis, decreased the risk of ovarian cancer (0. . The most recent study (31) did not investigate comorbidity of uterine fibroids with cancers but shows that the presence of breast cancer in the baseline assessment of the study population increased the risk of developing uterine fibroids by 1.5-fold while the presence of cervical or ovarian cancer decreased that risk 5.5-fold and 2-fold, respectively. The risk of uterine fibroids progressing toward leiomyosarcomata for their part is very low, with an incidence of 0.4 per 100,000 (51), vastly lower than the incidence of uterine fibroids.…”

“…The first studies used retrospective analyses of clinical data at local medical centres to report statistics on comorbidity ( 19 , 24 – 27 ); these were followed by larger-scale retrospective studies of medical insurance claims data ( 29 , 30 ). Finally, the results from long-term prospective cohort studies are emerging ( 28 , 31 ), which offer the exciting possibility of monitoring disease incidence, development, and comorbidity over the years.…”

“…In contrast, a Minnesota study of insurance claim data conducted in 2018 found an increased risk of endometriosis comorbidity with uterine fibroids in laparoscopically confirmed cases of endometriosis (aHR 4.0, 95% CI 3.5–4.7, P < 0.001). Prospective studies have the advantage of investigating the presence of endometriosis or uterine fibroids at the time of surgery for either of these conditions, as in a very recent 2021 study of Taiwanese women, with 14 years of follow-up ( 31 ). This study confirmed that the presence of uterine fibroids increases the risk of developing endometriosis and reported an adjusted hazard rate of 6.44 (95% CI 6.18–6.72).…”

A Case Report of Non-puerperal Uterine Inversion due to Submucosa Leiomyoma in a Young Virgin Woman

“…UL can have many side effects such as dyspareunia [3], increase the risk of endometriosis, postpartum hemorrhage, placenta previa, and reduced quality of life [4][5][6][7]. Uterine inversion (UI) is one of the rare complications of ULs.…”