Disordered eating behaviors during adolescence and risk of endometriosis: a prospective cohort study
Leslie V Farland, Holly R Harris, Kendrin R Sonneville
Neblett MF 2nd , Michael F. Neblett , Alison E Field, Jorge E Chavarro , Audrey J Gaskins, Stacey A Missmer, Sarah Thornburgh
Author affiliations (8)
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Department of Obstetrics and Gynecology, College of Medicine -...ROR
Disordered eating behaviors may impact the gynecologic health of adolescents through effects on menstrual cycle function and body size; however, few studies have evaluated these associations. This study aimed to prospectively investigate the associations between individual disordered eating behaviors during adolescence and the risk of subsequent endometriosis diagnosis.
Design
Prospective, longitudinal cohort (1996-2021).
Subjects
Female participants (n = 11,773) from the Growing Up Today Study.
Exposure
Frequency of binge eating, laxative use, and self-induced vomiting over the past year was self-reported on repeated questionnaires during follow-up.
Main Outcome Measures
Physician-diagnosed endometriosis was reported on repeated questionnaires during follow-up. Multivariable logistic regression models with generalized estimating equations were used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
Results
Over 25 years of follow-up, we identified 269 incident cases of endometriosis (2.3%), 190 of which were reported as laparoscopically confirmed. A total of 32% of girls reported ever binge eating, 14% reported self-induced vomiting to lose weight, and 9% reported ever using laxatives to lose weight. The odds of a laparoscopically-confirmed endometriosis diagnosis were more than three-fold higher (aOR = 3.07; 95% CI 1.74, 5.40) for girls who cumulatively reported self-induced vomiting more than monthly during follow-up, compared with girls who never reported self-induced vomiting. Cumulative exposure to binge eating during follow-up was not associated with diagnosis of laparoscopically-confirmed endometriosis; however, girls who reported the highest ever engagement in binge eating of weekly or more had 52% lower (aOR = 0.47; 95% CI 0.25, 0.90) odds of laparoscopically-confirmed endometriosis, compared with girls who reported less than weekly binge eating. Laxative use was not strongly associated with endometriosis diagnosis, although estimates were imprecise.
Conclusion
Females with a greater frequency of self-induced vomiting were more likely to be diagnosed with endometriosis during follow-up, whereas girls with a history of frequent binge eating had a lower likelihood of endometriosis diagnosis. We found no association between laxative use and endometriosis.
disordered eating adolescence endometriosis risk, eating behaviors teenage girls gynecological outcomes, prospective cohort study endometriosis etiology, Thornburgh Farland Harris endometriosis nutrition, Missmer Gaskins Chavarro reproductive epidemiology, anorexia bulimia adolescent endometriosis incidence, body image eating disorders pelvic pain, adolescent dietary patterns reproductive health outcomes, Fertility and Sterility endometriosis cohort 2026, energy restriction pubertal development endometriosis
PMID 41519253 41519253 DOI 10.1016/j.fertnstert.2025.12.027 10.1016/j.fertnstert.2025.12.027
Cite this article
Thornburgh, S., Farland, L. V., Harris, H. R., Sonneville, K. R., Neblett MF 2nd, Field, A. E., Chavarro, J. E., Missmer, S. A., & Gaskins, A. J. (2026). Disordered eating behaviors during adolescence and risk of endometriosis: a prospective cohort study. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2025.12.027
Thornburgh S, Farland LV, Harris HR, Sonneville KR, Neblett MF 2nd, Field AE, et al. Disordered eating behaviors during adolescence and risk of endometriosis: a prospective cohort study. Fertility and sterility. 2026. doi:10.1016/j.fertnstert.2025.12.027
Thornburgh, S., et al. "Disordered eating behaviors during adolescence and risk of endometriosis: a prospective cohort study." Fertility and sterility, 2026.
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