Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study

Abstract

OBJECTIVE We sought to identify risk factors for endometriosis and their consistency across study populations in the Endometriosis: Natural History, Diagnosis, and Outcomes (ENDO) Study. STUDY DESIGN In this prospective matched, exposure cohort design, 495 women aged 18–44 years undergoing pelvic surgery (exposed to surgery, operative cohort) were compared to an age- and residence-matched population cohort of 131 women (unexposed to surgery, populationcohort). Endometriosis was diagnosed visually at laparoscopy/laparotomy or by pelvic magnetic resonance imaging in the operative and population cohorts, respectively. Logistic regression estimated the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for each cohort. RESULTS The incidence of visualized endometriosis was 40% in the operative cohort (11.8% stage 3–4 by revised criteria from the American Society for Reproductive Medicine), and 11% stage 3–4 in the population cohort by magnetic resonance imaging. An infertility history increased the odds of an endometriosis diagnosis in both the operative (AOR, 2.43; 95% CI, 1.57–3.76) and population (AOR, 7.91; 95% CI, 1.69–37.2) cohorts. In the operative cohort only, dysmenorrhea (AOR, 2.46; 95% CI, 1.28–4.72) and pelvic pain (AOR, 3.67; 95% CI, 2.44–5.50) increased the odds of diagnosis, while gravidity (AOR, 0.49; 95% CI, 0.32–0.75), parity (AOR, 0.42; 95% CI, 0.28–0.64), and body mass index (AOR, 0.95; 95% CI, 0.93–0.98) decreased the odds of diagnosis. In all sensitivity analyses for different diagnostic subgroups, infertility history remained a strong risk factor. CONCLUSION An infertility history was a consistent risk factor for endometriosis in both the operative and population cohorts of the ENDO Study. Additionally, identified risk factors for endometriosis vary based upon cohort selection and diagnostic accuracy. Finally, endometriosis in the population may be more common than recognized.

Reproductive and Lifestyle Factors Associated with Endometriosis in a Large Cross-Sectional Population Sample

“…41,42 Parity may be inversely associated with endometriosis in this study because of reverse causation. We speculate that women who have endometriosis are less fertile and are thus less likely to end up having two or more children.…”

“…It is not clear whether endometriosis and infertility share a common cause or whether infertility is in the etiological pathway to endometriosis. 41 During the use of OC, ovulation is suppressed and the amount of menstrual bleeding is reduced, making OC an effective treatment option for endometriosis. Considering this mechanism, the use of OC might have the potential to also prevent the development of endometriosis; however, this could not be shown in our study.…”

Y a-t-il une place pour la cœlioscopie dans le parcours en assistance médicale à la procréation ?

“…En effet, l'endomé triose peut être totalement asymptomatique et l'infertilité en être la seule manifestation. L'é tude de cohorte observationnelle comparative ENDO-study a mis en é vidence que l'infertilité ou un anté cé dent de traitement pour celle-ci (sans diagnostic é tiologique) é tait d'importants facteurs de risque d'endomé triose [66]. De même, Berube et al diagnostiquent une endomé triose chez 30 % des 331 patientes infertiles et sans contexte douloureux pelvien [27], taux concordant avec les larges é tudes prospectives d'une population gé né rale, au sein desquelles l'endomé triose est plus importante en cas de difficulté de conception [29,67,68].…”

Magnetinio Rezonanso Tomografijos Reikšmė Diagnozuojant Endometriozę

“…reprodukcinio amžiaus moterų [1]. Endometriozės rizikos veiksniai yra šeiminė šios ligos anamnezė, ankstyva mėnesinių pradžia, piktnaudžia-vimas alkoholiu, lytiniai santykiai mėnesinių metu, nutukimas arba priešingai -mažas kūno svoris ir aplinkos užterš-tumas sunkiaisiais metalais [2,3]. Endometriozė kliniškai gali pasireikšti įvairiai: mėnesinių ciklo sutrikimu, skausmingais lytiniais santykiais, skausmu tuštinantis, lėtiniu dubens skausmu, nevaisingumu.…”