Study highlights importance of interplay between hormonal contraceptives and endometriosis

Recent research paper investigates the potential warning signs for endometriosis in women, specifically focusing on the early use of hormonal contraceptives (HC) and the failure to find a suitable method. The study is a retrospective cohort study conducted in Sweden and includes a cohort of 720,805 women aged 12-27 years from 2005-2017. The data from Swedish national registers were used, and the analysis includes both crude and adjusted hazard ratios with 95% confidence intervals, considering factors such as age, education level, civil status, parity, country of birth, and diagnoses of infertility, dysmenorrhea, or depression.

Results and Risk Factors

The results indicate that women who started HC at the ages of 12-14 years had a higher risk of receiving an endometriosis diagnosis than those who began at 17 years or older. Additionally, having tried more types of HCs was associated with a twofold increased risk of endometriosis, and using HC for more than 1 year was associated with a decreased risk of endometriosis. Women with endometriosis more commonly had dysmenorrhea, depression, or infertility.

Impact of HC Usage on Endometriosis Diagnosis

The study also found that women who were prescribed HCs at a young age had a more than twofold increased risk of being diagnosed with endometriosis later in life than those who received HCs after the age of 17 years. Using several different preparations of HC was also associated with an increased risk of a later endometriosis diagnosis, while a longer duration of HC use seemed to reduce the risk of receiving a diagnosis. The study also identified other associated factors such as dysmenorrhea, infertility, and depression with endometriosis.

Clinical and Research Implications

The research highlights the clinical implications for healthcare providers when considering contraceptive counseling, particularly when treating adolescents. It also emphasizes the importance of understanding the interplay between HCs and endometriosis in this vulnerable patient group. However, limitations include the difficulty in establishing causal relationships and the potential misclassification of outcomes due to a low prevalence of endometriosis in the control group. Nonetheless, the study findings contribute to the nuanced understanding of the onset of endometriosis and its relationship with HC usage and early warning signs.

Key Points

- The study is a retrospective cohort study conducted in Sweden, including 720,805 women aged 12-27 years from 2005-2017, using data from Swedish national registers. Factors such as age, education level, civil status, parity, country of birth, and diagnoses of infertility, dysmenorrhea, or depression were considered in the analysis.

- Results suggest that women who started hormonal contraceptives (HC) at ages 12-14 had a higher risk of receiving an endometriosis diagnosis compared to those who began at 17 years or older. Trying more types of HCs was associated with a twofold increased risk of endometriosis, while using HC for more than 1 year was associated with a decreased risk of endometriosis. Women with endometriosis also commonly had dysmenorrhea, depression, or infertility.

- Women prescribed HCs at a young age had a more than twofold increased risk of being diagnosed with endometriosis later in life compared to those who received HCs after the age of 17 years. Using several different preparations of HC was associated with an increased risk of a later endometriosis diagnosis, while a longer duration of HC use seemed to reduce the risk of receiving a diagnosis. Dysmenorrhea, infertility, and depression were also identified as associated factors with endometriosis.

- The study indicates clinical implications for healthcare providers when considering contraceptive counseling, particularly when treating adolescents. It emphasizes the importance of understanding the interplay between HCs and endometriosis in this patient group. However, limitations include the difficulty in establishing causal relationships and potential misclassification of outcomes due to a low prevalence of endometriosis in the control group.

- The findings contribute to the nuanced understanding of the onset of endometriosis and its relationship with HC usage and early warning signs. The study underscores the need for further research to better comprehend the interplay between hormonal contraceptives and endometriosis, especially in young women.

- Overall, the study provides valuable insights into the potential warning signs for endometriosis and highlights the complex relationship between early use of hormonal contraceptives, failed suitable methods, and the later diagnosis of endometriosis.

Reference –

Obern C, Olovsson M, Tydén T, Sundström-Poromaa I. Endometriosis risk and

hormonal contraceptive usage: A nationwide cohort study. BJOG. 2024;131(10):1352–1359. https://doi. org/10.1111/1471-0528.17812