Risk factors associated with endometriosis: importance of study population for characterizing disease in the Endo Study
Open accessAbstract
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, population cohort). 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.
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The study's findings are consistent with previous research showing positive associations between endometriosis and history of subfertility and dysmenorrhea and negative associations between gravidity and parity.
“Our findings are consistent with previous research showing the positive associations between endometriosis and history of subfertility and dysmenorrhea and the negative associations between gravidity and parity.36, 37, 38”
From Examining the co-occurrence of endometriosis and polycystic ovarian syndrome (2023) · cites this paper as [36]
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References 31 · Cited by 130
- Authors
- Peterson, C. M., Johnstone, E. B., Hammoud, A. O., Stanford, J. B., Varner, M. W., Kennedy, A., Chen, Z., Sun, L., Fujimoto, V. Y., Hediger, M. L., & Buck Louis, G. M.
- Affiliations
- University of Utah (US)
- National Institutes of Health (US)
- University of California, San Francisco (US)
- Corresponding author
- Peterson, C. Matthew
- ORCID
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2013-06
- Volume
- 208
- Issue
- 6
- Pages
- 451.e1-451.e11
- ISSN
- 0002-9378 (ISSN-L)
- PMC
- PMC4114145
- OpenAlex
- W2075422337
- Cited by
- 130
- References
- 31
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 11 · 2023: 12 · 2022: 13 · 2021: 14 · 2020: 16 · 2019: 12 · 2018: 6 · 2017: 6 · 2016: 7 · 2015: 8 · 2014: 6 · 2013: 2
- FWCI
- 9.26
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health
- U.S. Public Health Service (10001406-02)
- National Institute of Diabetes and Digestive and Kidney Diseases (N01-DK-6-3427, N01-DK-6-3428)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (Z01HD008829, ZIAHD008829)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- endometriosis, risk factors, infertility history, dysmenorrhea, pelvic pain, pelvic surgery, population selection, natural history (disease), MRI diagnosis, parity, gravidity, body mass index, endometriosis staging
- MeSH terms
- Adolescent, Adult, Dysmenorrhea, Endometriosis, Female, Humans, Infertility, Laparotomy, Magnetic Resonance Imaging, Parity, Pelvis, Laparoscopy, Pregnancy, Prospective Studies, Risk Factors, Cohort Studies, Incidence, Logistic Models, Odds Ratio, Case-Control Studies, Pelvic Pain, Gravidity, Young Adult
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