Women with endometriosis have high risk for several chronic diseases
Endometriosis is a chronic estrogen-dependent disorder affecting 6%-10% of women in the reproductive age. It may cause dysmenorrhea, chronic abdominal/pelvic pain, and infertility. The etiology of endometriosis is multifactorial, including genetic, environmental, and lifestyle components. Abnormalities in steroidogenesis, immune response, angiogenesis, inflammation, and apoptosis have been identified as possible predisposing factors in the pathogenesis of endometriosis, and they may act as pathogenic features to endometriosis-related comorbidities as well. The symptoms of endometriosis can be nonspecific and overlap with gastrointestinal and pelvic pain-causing diseases, resulting in misdiagnoses and diagnostic delays. Normalization of endometriosis-related symptoms, especially the ones related to menstrual cycles, is another main cause of diagnostic delay.
Endometriosis is associated with an increased risk of nongynecological comorbidities, such as autoimmune diseases, bowel diseases, migraine, mental, and cardiovascular diseases.
The aim of this study by Henna-Riikka Rossi et al was to investigate the prevalence of nongynecological diagnoses and comorbidities in women with endometriosis by exploring the International Classification of Diseases (ICD) diagnoses in a prospective populationbased data set.
Study participants with and without endometriosis were identified from a general population-based birth cohort. The analyzed data, linking to the national hospital discharge registers, spanned up to the age of 50 years. Endometriosis case identification was based on national register data and self-reported diagnoses, producing a study population of 349 women with endometriosis and 3,499 women without endometriosis. International Classification of Diseases diagnosis codes from 1968 to 2016 were accumulated from the Finnish national Care Register for Health Care, whereas self-reported symptoms and continuous medication usage data were collected from the questionnaires distributed at age 46. The associations between endometriosis and comorbidities were assessed using logistic regression models that included several covariates. The odds ratios and 95% confidence intervals (CIs) were modeled. Endometriosis subtype and temporal analyses were also performed.
Women with endometriosis were on average twice as likely to have hospital-based nongynecological diagnoses as women without endometriosis. In more detail, endometriosis was associated with allergies, infectious diseases, pain-causing diseases, and respiratory diseases. Moreover, the affected women presented with nonspecific symptoms and signs (aOR 3.56), especially abdominal and pelvic pain (aOR 4.33) more often compared with nonendometriosis controls. The temporal analysis revealed that diagnoses accumulated at a significantly younger age among women with endometriosis than in nonendometriosis counterparts.
This population-based study shows the independent association of endometriosis with several diseases and symptoms by the end of fertile age. Affected women presented more often with migraine, musculoskeletal diseases, mood disorders, immune and respiratory diseases, pain and unspecific symptoms and signs as well as abnormal clinical and laboratory findings compared with those without endometriosis. Despite the increased comorbidity rate, high medication usage in endometriosis group at the age of 46 was mainly attributed to the high use of hormonal preparation
“Our findings suggest that women with endometriosis are at a high risk of several chronic diseases warranting deeperunderstanding of these associations by future mechanistic studies. Early diagnosis of endometriosis without a long diagnostic delay is crucial for improving women’s health and reducing the social, economic, and personal burden of endometriosis and related disorders. Lastly, affected women should be given more attention and targeted resources in health care systems to achieve more efficient and targeted care in multidisciplinary settings.”
Source: Henna-Riikka Rossi, Outi Uimari, Anna Terho,; Fertility and Sterility® Vol. 119, No. 1, January 2023 0015-0282
https://doi.org/10.1016/j.fertnstert.2022.09.361
