Laparoscopically confirmed endometriosis indicates risk of early natural menopause: JAMA

USA: A new study found an increased incidence of early natural menopause (ENM) among women with laparoscopically diagnosed endometriosis. These women, as compared to those without endometriosis, maybe at a higher risk of having a shorter reproductive lifespan, especially if they were nulliparous or never used oral contraceptives. This study was conducted by Madhavi Thombre Kulkarni & team and the findings were published in the Journal of American Medical Association (JAMA). 

ENM has been linked to a shorter reproductive lifespan, an increased risk of cardiovascular illness, and an increased chance of death. Although the risks of endometrioma surgery for ovarian reserve are well documented, the relationship between endometriosis and menopausal time is yet unknown. The objective of this study was to look at the link between endometriosis and the risk of ENM.

This large population-based cohort research examined data from the Nurses' Health Study II cohort surveys from 1989 to 2015. At baseline or enrolment in 1989, the sample consisted of premenopausal women aged 25 to 42 years. The cumulative follow-up rate was higher than 90%, and participants were followed until the beginning of ENM, the age of 45 years, hysterectomy, oophorectomy, cancer diagnosis, death, loss to follow-up, or the end of follow-up in May 2017, whichever came first. Data analyses were carried out between October 26, 2020, and April 27, 2021. The status of endometriosis diagnosis was asked about in the biennial surveys, with participants reporting physician diagnosis and if the diagnosis was confirmed laparoscopically. The major result was natural menopause before the age of 45. Every two years, the menopause status was evaluated.

The key findings of this study were as follow:

1. The study comprised 106 633 premenopausal women with a mean (SD) age of 34.8 (4.3) years at the start, 3921 of whom had laparoscopically diagnosed endometriosis.

2. During the 1 508 462 person-years of follow-up, 6640 individuals were diagnosed with endometriosis, 99 993 were never diagnosed with endometriosis, and 2542 had ENM.

3. Laparoscopically confirmed endometriosis was associated with a 50% increased incidence of ENM in the age- and calendar time–adjusted model. After controlling for race and ethnicity, as well as time-varying anthropometric and behavioral characteristics, a comparable risk was discovered. The HR of ENM was decreased yet substantial after adjusting for reproductive variables.

4. Women who were nulliparous after stratifying by parity or who never used oral contraceptives after stratifying by oral contraceptive use had a higher incidence of ENM.

5. When stratified by body mass index, cigarette smoking status, or history of infertility due to ovulatory dysfunction, no significant variations in the link between endometriosis and ENM were found.

In conclusion, after adjusting for reproductive characteristics, there was some confounding effect. Endometriosis may be a major risk factor for ENM, and women with endometriosis, especially those who are nulliparous and never use OCs, maybe at a higher risk of having a shorter reproductive duration.

Reference:

Thombre Kulkarni M, Shafrir A, Farland LV, et al. Association Between Laparoscopically Confirmed Endometriosis and Risk of Early Natural Menopause. JAMA Netw Open. 2022;5(1):e2144391. doi:10.1001/jamanetworkopen.2021.44391