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Cited by 63Endometriosis Research and TreatmentChild Abuse and TraumaEctopic Pregnancy Diagnosis and Management

Maltreatment during childhood: a risk factor for the development of endometriosis?

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Liebermann, C, Kohl Schwartz, A S, Charpidou, T, Geraedts, K, Rauchfuss, M, Wölfler, M, von Orelli, S, Häberlin, F +4 more·2018·Human Reproduction
DOI 10.1093/humrep/dey111
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Abstract

STUDY QUESTION: Is maltreatment during childhood (MC), e.g. sexual abuse, physical abuse, emotional abuse and neglect, associated with diagnosis of endometriosis? SUMMARY ANSWER: Childhood sexual abuse, emotional abuse/neglect and inconsistency experiences were associated with the diagnosis of endometriosis while no such association was found for physical abuse/neglect and other forms of maltreatment. WHAT IS KNOWN ALREADY: Symptoms of endometriosis such as chronic pelvic pain, fatigue and depression, are correlated with MC, as are immune reactions linked to endometriosis. These factors support a case for a potential role of MC in the development of endometriosis. STUDY DESIGN, SIZE, DURATION: The study was designed as a multicentre retrospective case-control study. Women with a diagnosis of endometriosis were matched to control women from the same clinic/doctor's office with regard to age (±3 years) and ethnic background. A total of 421 matched pairs were included in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with endometriosis and control women were recruited in university hospitals, district hospitals, and doctors' offices in Germany, Switzerland and Austria. A German-language version of the Childhood Trauma Questionnaire (CTQ) was used to evaluate MC. Diagnosis of endometriosis was confirmed histologically and classified according to ASRM criteria. MAIN RESULTS AND THE ROLE OF CHANCE: Women with endometriosis reported significantly more often than control women a history of sexual abuse (20%/14%, P = 0.0197), emotional abuse (44%/28%, P < 0.0001), emotional neglect (50%/42%, P = 0.0123) and inconsistency experiences (53%/41%, P = 0.0007). No statistically significant differences could be demonstrated for physical abuse/neglect (31%/26%, P = 0.1738). Combinations of different abuse/neglect experiences were described significantly more often in women with endometriosis. Frequencies of other MC, i.e. violence against the mother (8%/7%, P = 0.8222), drug abuse in the family (5%/3%, P = 0.0943), mentally handicapped family members (1%/1%, P = 0.7271), suicidal intentions in the family (6%/4%, P = 0.2879) and family members in prison (1%/1%, P = 0.1597) were not statistically different in women with endometriosis and control women. LIMITATIONS, REASONS FOR CAUTION: Some control women might present asymptomatic endometriosis, which would lead to underestimation of our findings. The exclusion of pregnant women may have biased the results. Statistical power for sub-analyses of physical abuse/neglect and sexual abuse was limited. WIDER IMPLICATIONS OF THE FINDINGS: A link to MC needs to be considered in women with endometriosis. As there are effective strategies to avoid long-term consequences of MC, healthcare professionals should inquire about such experiences in order to be able to provide treatment for the consequences as early as possible. STUDY FUNDING/COMPETING INTEREST(S): None. TRIAL REGISTRATION NUMBER: Endo_QoL NCT02511626.

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  • A more recent study of 421 endometriosis patients and an equally large control group produced an odds ratio of 1.1 for sexual abuse (marginally significant statistically) and 1.2 both for emotional abuse and a combination of the two over and against the control group.

    “A more recent study of 421 endometriosis patients and an equally large control group produced an odds ratio of 1.1 for sexual abuse (marginally significant statistically) and 1.2 both for emotional abuse and a combination of the two over and against the control group [9].”

    From Endometriosis: patient–doctor communication and psychological counselling (2023) · cites this paper as [9]

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Research works printed but not linked: 2

  1. Harrop-Griffiths J, Katon W, Walker E, Holm L, Russo J, Hickok L. The association between chronic pelvic pain, psychiatric diagnoses, and child- hood sexual abuse. Obstet Gynecol 1988;71:589-594.
  2. Klinitzke G, Romppel M, Hauser W, Brahler E, Glaesmer H. The German Version of the Childhood Trauma Questionnaire (CTQ): psychometric characteristics in a representative sample of the general population. Psychother Psychosom Med Psychol 2012;62:47-51.

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Authors
Liebermann, C., Kohl Schwartz, A. S., Charpidou, T., Geraedts, K., Rauchfuss, M., Wölfler, M., von Orelli, S., Häberlin, F., Eberhard, M., Imesch, P., Imthurn, B., & Leeners, B.
Affiliations
  • University Hospital Zurich (CH)
  • Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
  • Kantonsspital Baden (CH)
  • Charité – Universitätsmedizin Berlin (DE)
  • Medical University of Graz (AT)
  • Triemli Hospital Zurich, Birmesdorferstrasse 497, Zurich, Switzerland
  • Kantonsspital St. Gallen (CH)
  • Spitäler Schaffhausen (CH)
Corresponding author
Leeners, B
ORCID
Venue
Human Reproduction
Publisher
Oxford University Press (OUP)
Published
2018-06-26
Volume
33
Issue
8
Pages
1449-1458
ISSN
  • 0268-1161 (ISSN-L)
  • 1460-2350
DOI
10.1093/humrep/dey111
OpenAlex
W2810345043
Cited by
63
References
55
Citations by year
2026: 5 · 2025: 8 · 2024: 11 · 2023: 11 · 2022: 7 · 2021: 5 · 2020: 7 · 2019: 6 · 2018: 3
FWCI
5.60
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/about_us/legal/notices (vor, 1 d)
Locations
  • Human Reproduction (publishedVersion)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
  • RERO DOC (Universität Bern) (submittedVersion)
  • BORIS (University Library Bern) (submittedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
Keywords
endometriosis, child abuse, child sexual abuse, emotional abuse, emotional neglect, physical abuse, neglect, domestic violence, Childhood Trauma Questionnaire, risk factors, women's health, chronic pelvic pain, depression, immune response, family history of suicide
MeSH terms
Psychological Distress, Adolescent, Adult, Age Factors, Austria, Child, Child Abuse, Child Abuse, Sexual, Child, Preschool, Endometriosis, Female, Germany, Humans, Middle Aged, Retrospective Studies, Risk Factors, Stress, Psychological, Switzerland, Risk Assessment

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