Reproductive History and Endometriosis Among Premenopausal Women
Abstract
OBJECTIVE: To clarify the temporal complexities of the relation between reproductive factors and endometriosis. METHODS: We analyzed 10 years of prospective data from the Nurses' Health Study II cohort. Information was obtained through questionnaires sent every 2 years to 116,678 women aged 25-42 years when enrolled in 1989. Cox proportional hazards models were used to adjust for age, calendar time, and confounding variables. RESULTS: During 726,205 woman-years of follow-up, 1,721 cases of laparoscopically confirmed endometriosis were reported among women with no past infertility. Greater incidence was observed among women with an earlier age at menarche (rate ratio of 1.3 comparing menarche at age < 10 to age 12 years; 95% confidence interval [CI] 1.0-1.8; P value, test for trend < .001) and shorter cycle length during late adolescence (rate ratio of 1.3 comparing < 26 days to 26-31 days; 95% CI 1.1-1.5). Time to cycle regularity was not associated with risk. Among parous women, a linear decrease in risk was observed with number of liveborn children (rate ratio of 0.5 comparing > 3 with 2 children; 95% CI 0.4-0.7; P value, test for trend < .001) and lifetime duration of lactation if time since last birth was less than 5 years (rate ratio of 0.2 comparing > 23 months with never; 95% CI 0.1-0.4; P value, test for trend < .001). CONCLUSION: Hormonal and anatomical changes associated with menstruation and pregnancy may affect the rate of laparoscopically confirmed endometriosis. Within this cohort, risk was greatest among nulliparous women with earlier age at menarche and shorter menstrual cycles. Among parous women, parity and lifetime duration of lactation were associated with decreased risk.
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Endometriosis is an estrogen-dependent inflammatory disease occurring in women of reproductive age that generally becomes inactive with menopause unless post-menopausal hormone therapy is used.
“Endometriosis is an estrogen-dependent inflammatory disease that occurs in women of reproductive age, and generally becomes inactive with menopause, unless a woman uses post-menopausal hormone therapy (Goodman et al., 1989;Takayama et al., 1998;Missmer et al., 2004;Cumiskey et al., 2008).”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Missmer et al., 2004
Multiparity is associated with a lower risk of endometriosis.
“multiparity is associated with a lower risk of endometriosis”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Missmer et al., 2004
Age at menarche and menstrual cycle characteristics have been robustly associated with endometriosis.
“as they [1] have been robustly associated with endometriosis (34–38)”
In prospective studies, increasing number of live births has been linearly associated with decreasing incidence of endometriosis.
“In prospective studies, increasing number of live births has been linearly associated with decreasing incidence of endometriosis (38).”
Women who have used oral contraceptives for prolonged periods will be protected from an increased risk of endometriosis-associated ovarian cancer.
“women who have used OC for prolonged periods will be protected from an increased risk of endometriosis-associated ovarian cancer”
From “Waiting for Godot”: a commonsense approach to the medical treatment of endometriosis (2011) · cites this paper as Missmer et al., 2004
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- Authors
- Missmer, S. A., Hankinson, S. E., Spiegelman, D., Barbieri, R. L., Malspeis, S., Willett, W. C., & Hunter, D. J.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Missmer, Stacey A.
- Hankinson, Susan E.
- Malspeis, Susan
- Willett, Walter C.
- Hunter, David J.
- Venue
- Obstetrics & Gynecology
- Published
- 2004-11
- Volume
- 104
- Issue
- 5, Part 1
- Pages
- 965-974
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W2313825310
- Cited by
- 237
- References
- 33
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 6 · 2023: 14 · 2022: 14 · 2021: 16 · 2020: 13 · 2019: 17 · 2018: 18 · 2017: 14 · 2016: 15 · 2015: 7 · 2014: 8 · 2013: 10 · 2012: 10
- FWCI
- 4.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (CA50385, R01CA050385)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R03HD040882, HD40882)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- endometriosis, reproductive history, age at menarche, menstrual cycle length, parity, number of live births, lactation length, nulliparity, premenopausal women, Nurses' Health Study II, endometriosis risk factors
- MeSH terms
- Adult, Endometriosis, Female, Humans, Lactation, Menarche, Menstrual Cycle, Parity, Prospective Studies, Risk Factors, Proportional Hazards Models
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