Endometriosis Linked to Higher Type 2 Diabetes Risk: Study
USA: Researchers have found in a new study of nearly 3 million women that those with endometriosis had a 46% higher risk of developing type 2 diabetes. The risk varied by the type of endometriosis, suggesting the condition may have important metabolic health implications beyond reproductive health and could help guide future diabetes screening and prevention.
The findings are from the Advancing Research on Cardiovascular Health and Endometriosis Study (ARCHES), a population-based retrospective cohort study published in Diabetologia by Maggie Fuzak Nunziato, College of Public Health, George Mason University, Fairfax, VA, USA, and colleagues.
Endometriosis is a chronic inflammatory condition characterized by the presence of endometrial-like tissue outside the uterus. While previous research has generally found little or no association between endometriosis and type 2 diabetes, the researchers noted that earlier studies may not have adequately accounted for differences between endometriosis subtypes or metabolic risk groups.
The investigators analyzed data from 2,939,364 individuals assigned female at birth in the Utah Population Database between 1996 and 2021. Endometriosis and its clinical subtypes were identified using diagnostic codes, while new cases of type 2 diabetes were tracked during follow-up. Participants were followed for an average of 10.8 years, during which 99,978 were diagnosed with endometriosis.
The key findings were:
- Endometriosis was associated with a 46% higher risk of developing type 2 diabetes compared with no endometriosis (adjusted HR 1.46).
- The association differed substantially by endometriosis subtype.
- The strongest associations were seen with endometriosis at other specified or unspecified sites, with risks more than twice as high compared with women without endometriosis.
- The relationship was stronger among premenopausal women, who had a 55% higher risk of type 2 diabetes.
- Women with a BMI below 30 kg/m² showed a particularly strong association, with more than twice the risk of type 2 diabetes.
- The increased risk was observed regardless of a history of gestational diabetes.
The researchers suggested that inflammatory and hormonal disturbances associated with endometriosis could potentially contribute to metabolic dysfunction and insulin resistance. However, the study was observational, meaning the findings demonstrate an association rather than proving that endometriosis directly causes type 2 diabetes.
The authors also cautioned that residual confounding and differences in healthcare utilization or diabetes detection could have influenced the results. Nevertheless, the findings indicate that metabolic risk may differ considerably across endometriosis subtypes and patient characteristics.
The study highlights the possibility that endometriosis could serve as an indicator of longer-term metabolic risk, including among women who would not traditionally be considered at high risk for type 2 diabetes. Further research is needed to clarify the biological mechanisms connecting endometriosis with metabolic disease and determine whether targeted screening or preventive strategies could benefit affected women.
Reference:
Fuzak Nunziato, M., Yan, B., Schliep, K.C. et al. Endometriosis subtypes and risk of type 2 diabetes: the Advancing Research on Cardiovascular Health and Endometriosis Study (ARCHES) retrospective cohort study. Diabetologia (2026). https://doi.org/10.1007/s00125-026-06828-w
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