Cited by 70Endometriosis Research and TreatmentGynecological conditions and treatmentsDiagnosis and treatment of tuberculosis

Increased Risk of Endometriosis in Patients With Lower Genital Tract Infection: A Nationwide Cohort Study

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Lin, Wu-Chou, Chang, Cherry Yin-Yi, Hsu, Yu-An, Chiang, Jen-Huai, Wan, Lei·2016·Medicine

Abstract

Endometriosis results from the ectopic invasion of endometrial glands and stroma in the peritoneal cavity. The exact etiology of endometriosis is still unknown. It has, however, been shown that there are higher numbers of Escherichia coli in menstrual blood, and higher endotoxin levels in menstrual fluid, as well as, in the peritoneal fluid of patients with endometriosis. In this study, we aimed to determine whether lower genital tract infections could increase the risk of endometriosis.We used the Taiwan National Health Insurance database to conduct a population-based cohort study. We included patients diagnosed with inflammatory diseases of the cervix, vagina, and vulva, and a control group comprising patients matched by age, sex, and comorbidities but without inflammatory diseases of the cervix, vagina, or vulva.A total of 79,512 patients were included in the inflammatory disease group and an equal number of control individuals were selected. The incidence of endometriosis (hazard ratio, 2.01; 95% confidence interval, 1.91-2.12; P < 0.001) was higher among patients than controls. Cox proportional hazards models showed that irrespective of comorbidities, lower genital tract infection was an independent risk factor for endometriosis.Patients with lower genital tract infections exhibit a substantially higher risk for developing endometriosis.

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  • Endometriosis is associated with higher concentrations of Escherichia coli in menstrual blood, with vaginal infections, and with chronic endometritis.

    “Endometriosis is associated with higher concentrations of Escherichia coli in menstrual blood (134, 135), with vaginal infections (136), and with chronic endometritis (137).”

    From Pathogenesis of endometriosis: The genetic/epigenetic theory (2019) · cites this paper as [136]

  • Endometriosis is associated with vaginal and pelvic infection and with an important metabolome in the uterine and peritoneal cavities.

    “In addition, we recently realized the association of endometriosis with vaginal and pelvic infection (78, 136, 138) and the presence of an important metabolome in the uterine and peritoneal cavities.”

    From Pathogenesis of endometriosis: The genetic/epigenetic theory (2019) · cites this paper as [136]

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Authors
Lin, W.-C., Chang, C. Y.-Y., Hsu, Y.-A., Chiang, J.-H., & Wan, L.
Affiliations
Asia University (TW)
Corresponding author
  • Hsu, Yu-An
  • Wan, Lei
Venue
Medicine
Published
2016-03
Volume
95
Issue
10
Pages
e2773
ISSN
0025-7974 (ISSN-L)
OpenAlex
W2293771134
Cited by
70
References
48
Citations by year
2026: 1 · 2025: 7 · 2024: 6 · 2023: 14 · 2022: 4 · 2021: 7 · 2020: 10 · 2019: 9 · 2018: 8 · 2017: 4
FWCI
9.31
Type
journal article
Language
en
Open access
Licence
cc-by-nd
Locations
  • Medicine (publishedVersion, cc-by-nd)
  • PubMed Central (publishedVersion, cc-by-nd)
  • PubMed (publishedVersion)
Funders
  • National Research Program for Biopharmaceuticals (MOST 104-2325-B-039 -005)
  • China Medical University (CMU102-ASIA-09)
  • Division of Materials Research
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Surgery › Diagnosis and treatment of tuberculosis
Keywords
endometriosis, lower genital tract infection, endometriosis risk factors, cervicitis, vaginal infection, vulvovaginitis, Escherichia coli, endotoxin, menstrual blood, peritoneal fluid, endometriosis etiology
MeSH terms
Adult, Endometriosis, Female, Humans, Middle Aged, Retrospective Studies, Risk Factors, Taiwan, Comorbidity, Incidence, Proportional Hazards Models, Databases, Factual, Reproductive Tract Infections

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