Endometriosis and Fibroids Linked to Long-Term Premature Mortality Risk, finds research
Researchers have established that endometriosis and uterine fibroids significantly raise long-term risks of premature mortality, or death before the age of 70. These associations are not limited to reproductive ages; they include highly increased risks of death from cancers of the female genital system, diseases of the respiratory system outside cancer, and nervous system disorders. A recent study was conducted by Wang YX. and colleagues which was published in the BMJ journal.
It was an observational cohort study of the Nurses' Health Study II in the United States from 1989 to 2019. The data were collected for the analysis of premature death effects of such conditions. The prospective cohort study included 110,091 women, aged 25-42 years in 1989, who did not have a history of hysterectomy before diagnosis of endometriosis or fibroids, cardiovascular diseases, or cancer. Over the 27.2 years of follow-up, data were collected from biennial questionnaires and analyzed using Cox proportional hazards models to estimate hazard ratios for total and cause-specific premature mortality.
Key Findings
Premature Death Incidence:
Women with laparoscopically confirmed endometriosis had a crude incidence of 2.01 per 1000 person-years compared to 1.40 per 1000 person-years for those without endometriosis.
Hazard Ratios for Premature Mortality:
Endometriosis was associated with a 19% higher risk of premature death in age-adjusted models (HR: 1.19; 95% CI, 1.09-1.30), which increased to 31% after adjusting for behavioral factors (HR: 1.31; 95% CI, 1.20-1.44).
There was no association between overall preterm mortality and uterine fibroids (HR: 1.03; 95% CI, 0.95-1.11) but a risk of 2.32 times of dying from gynecological cancers was found (HR: 2.32; 95% CI, 1.59-3.40).
Cause-Specific Mortality
There was a significant increased risk of death from the following diseases in endometriosis:
Malignant neoplasm of organs of the gynecological system: HR 2.76 (95% CI, 1.79-4.26).
Diseases of the nervous system: HR 2.50 (95% CI, 1.40-4.44).
Non-malignant respiratory diseases: HR 1.95 (95% CI, 1.11-3.41).
Senility and ill-defined diseases: HR 1.80 (95% CI, 1.19-2.73).
Combined Conditions:
Women with both endometriosis and fibroids had an increased risk of all-cause premature mortality, with differences in cardiovascular and respiratory disease mortality.
This study points out that women with previous endometriosis and uterine fibroids have greater risks of premature mortality by gynecological cancers and non-cancer causes. Such a finding emphasizes the importance of viewing gynecological conditions under a holistic approach to improve long-term health outcomes.
Reference:
Wang, Y.-X., Farland, L. V., Gaskins, A. J., Wang, S., Terry, K. L., Rexrode, K. M., Rich-Edwards, J. W., Tamimi, R., Chavarro, J. E., & Missmer, S. A. (2024). Endometriosis and uterine fibroids and risk of premature mortality: prospective cohort study. BMJ (Clinical Research Ed.), 387, e078797. https://doi.org/10.1136/bmj-2023-078797
