Kvaskoff, M., Mu, F., Terry, K. L., Harris, H. R., Poole, E. M., Farland, L., & Missmer, S. A. (2015). Endometriosis: a high-risk population for major chronic diseases? Human Reproduction Update, 21(4), 500-516. https://doi.org/10.1093/humupd/dmv013
Kvaskoff M, Mu F, Terry KL, Harris HR, Poole EM, Farland L, Missmer SA. Endometriosis: a high-risk population for major chronic diseases? Hum Reprod Update. 2015;21(4):500-516. doi:10.1093/humupd/dmv013
Kvaskoff, Marina, et al. "Endometriosis: a high-risk population for major chronic diseases?" Human Reproduction Update, vol. 21, no. 4, 2015, pp. 500-516.
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 -...03m2x1q45
Linked to ROR, the Research Organization Registry
RRM Academy Synopsis
Endometriosis is linked to higher risk of several chronic diseases
A 2015 review of dozens of studies found higher rates of heart disease, asthma, and some autoimmune conditions among women with endometriosis. The same review linked endometriosis to a higher risk of ovarian cancer, and to a lower risk of cervical cancer.
Study at a glance, 2015 review of 21 studies on ovarian cancer: Endometriosis was linked to higher risk of several chronic diseases. Source: Kvaskoff M et al., 2015, PMID 25765863.
Key Findings
Of 21 studies on ovarian cancer, 20 reported a positive association with endometriosis, and 16 of those reported statistically significant findings.
A pooled analysis of 13 case–control studies found an odds ratio of 1.46 (95% CI 1.31–1.63) for self-reported endometriosis and invasive ovarian cancer. Subtype analyses suggested a 3-fold risk for clear-cell tumors.
Breast cancer findings conflicted: three studies reported significant positive associations, four found no clear association, and four reported an inverse relation. Seven of 12 melanoma studies suggested a positive association.
In the Nurses' Health Study II, endometriosis was associated with myocardial infarction (RR 1.52, 95% CI 1.17–1.98) and with any of three coronary heart disease events combined (RR 1.62, 95% CI 1.39–1.89).
A Danish retrospective cohort reported significantly increased risks of systemic lupus erythematosus (SIR 1.6), Sjögren's syndrome (SIR 1.6) and multiple sclerosis (SIR 1.2) in women with endometriosis.
Interpretation
This 2015 review pulled together findings from many studies on endometriosis and later disease risk. In one large study, hysterectomy and ovary removal explained part of the link to heart disease. The pattern points to treatment itself as a factor, alongside the disease. The authors note that mediation analyses could trace this link directly. Larger, stage-specific studies could build on these findings.
RRM Context
Restorative reproductive medicine looks for root causes, including in endometriosis. The authors name two likely drivers of later disease risk: hormone treatments and hysterectomy, alongside the disease itself. Studies that track the disease apart from its treatment, by stage and type, speak to that root-cause question.
Our editorial summary of this paper, not the article's abstract.
Abstract
Background
Despite an estimated prevalence of 10% in women, the etiology of endometriosis remains poorly understood. Over recent decades, endometriosis has been associated with risk of several chronic diseases, such as cancer, autoimmune diseases, asthma/atopic diseases and cardiovascular diseases. A deeper understanding of these associations is needed as they may provide new leads into the causes or consequences of endometriosis. This review summarizes the available epidemiological findings on the associations between endometriosis and other chronic diseases and discusses hypotheses for underlying mechanisms, potential sources of bias and methodological complexities.
Methods
We performed a comprehensive search of the PubMed/Medline and ISI Web of Knowledge databases for all studies reporting on the associations between endometriosis and other diseases published in English through to May 2014, using numerous search terms. We additionally examined the reference lists of all identified papers to capture any additional articles that were not identified through computer searches.
Results
We identified 21 studies on the associations between endometriosis and ovarian cancer, 14 for breast cancer, 8 for endometrial cancer, 4 for cervical cancer, 12 for cutaneous melanoma and 3 for non-Hodgkin's lymphoma, as well as 9 on the links between endometriosis and autoimmune diseases, 6 on the links with asthma and atopic diseases, and 4 on the links with cardiovascular diseases. Endometriosis patients were reported to be at higher risk of ovarian and breast cancers, cutaneous melanoma, asthma, and some autoimmune, cardiovascular and atopic diseases, and at decreased risk of cervical cancer.
Conclusions
Increasing evidence suggests that endometriosis patients are at higher risk of several chronic diseases. Although the underlying mechanisms are not yet understood, the available data to date suggest that endometriosis is not harmless with respects to women's long-term health. If these relationships are confirmed, these findings may have important implications in screening practices and in the management and care of endometriosis patients.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
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