The Relation of Endometriosis to Menstrual Characteristics, Smoking, and Exercise
Abstract
We compared menstrual characteristics and constitutional factors in 268 white women with primary infertility due to endometriosis and in 3,794 white women admitted for delivery at seven collaborating hospitals from 1981 to 1983. Adjusting for confounding factors, including location, age, religion, and education, women with short-cycle lengths (less than or equal to 27 days) and longer flow (greater than or equal to one week) had more than double the risk for endometriosis compared with women with longer cycle lengths and shorter duration of flow. There was a trend for increasing risk for endometriosis to be associated with increasing menstrual pain. Adjusting for these menstrual characteristics, we found decreased risk for endometriosis associated with smoking or exercise that was largely confined to women who began either habit at an early age and were heavier smokers or more strenuous exercisers. We conclude that risk for endometriosis may relate to menstrual factors that predispose to greater pelvic contamination with menstrual products and to constitutional factors that influence endogenous hormonal levels.
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Early menarche before the age of 11 is associated with the risk of endometriosis.
“epidemiological studies analyzing the cycle of women with endometriosis have shown that the early first cycle (before the age of 11) is associated with the risk of endometriosis [43,44,45,46]”
From Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature) (2021) · cites this paper as [43]
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- Authors
- Cramer, D. W.
- Corresponding author
- Cramer, Daniel W.
- ORCID
- Cramer, Daniel W.
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1986-04-11
- Volume
- 255
- Issue
- 14
- Pages
- 1904
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2015536508
- Cited by
- 367
- References
- 16
- Citations by year
- 2026: 2 · 2025: 16 · 2024: 9 · 2023: 7 · 2022: 6 · 2021: 15 · 2020: 9 · 2019: 6 · 2018: 8 · 2017: 16 · 2016: 12 · 2015: 9 · 2014: 13 · 2013: 8 · 2012: 10
- FWCI
- 4.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hd002822-007)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (N01-HD-02822)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- endometriosis, menstrual characteristics, menstrual cycle length, menstrual flow, dysmenorrhea, smoking, physical activity, primary infertility, risk factors, endogenous hormones
- MeSH terms
- Adolescent, Adult, Endometriosis, Physical Exertion, Female, Humans, Menstruation Disturbances, Pregnancy, Risk, Smoking
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