A new study published in The BMJ has found that women with a history of endometriosis and uterine fibroids may face a higher long-term risk of premature death. The research, conducted in the United States, adds to the growing body of evidence surrounding these common reproductive health disorders.
Endometriosis occurs when tissue similar to the uterus lining grows outside the womb, affecting areas such as the ovaries and fallopian tubes. Uterine fibroids are non-cancerous growths that develop within or around the uterus. While both conditions are prevalent among women of reproductive age, their long-term implications for health, particularly regarding mortality before age 70, have not been fully understood.
To investigate this issue, researchers analyzed data from 110,091 women participating in the Nurses’ Health Study II. These women, aged 25 to 42 in 1989, had no prior history of hysterectomy, cardiovascular disease, or cancer before being diagnosed with endometriosis or fibroids. Starting in 1993, participants reported any diagnoses of endometriosis (confirmed by laparoscopy) and uterine fibroids (confirmed by ultrasound or hysterectomy) every two years.
The study accounted for various factors that could influence health outcomes, including age, ethnicity, reproductive history, hormone replacement therapy, oral contraceptive use, regular use of aspirin or anti-inflammatory drugs, and other health-related issues.
Over the 30 years of monitoring, the study recorded 4,356 premature deaths, including 1,459 from cancer, 304 from cardiovascular diseases, and 90 from respiratory diseases. The overall rate of all-cause premature death was 2 per 1,000 person-years for women with confirmed endometriosis, compared to 1.4 per 1,000 person-years for those without.
After adjusting for age and other confounding factors such as body mass index (BMI), diet quality, physical activity, and smoking status, the study found that endometriosis was associated with a 31% higher risk of premature death, primarily linked to deaths from gynecological cancers. Conversely, while uterine fibroids did not show a relationship with all-cause premature death, they were associated with an increased risk of death from gynecological cancers.
The researchers noted that their findings are observational and based on self-reported data, which may be subject to inaccuracies. Additionally, the study’s predominantly white healthcare worker demographic may limit the generalizability of the results to other populations. The possibility of unmeasured factors influencing the outcomes cannot be dismissed.
Despite these limitations, the large sample size and nearly three decades of follow-up help mitigate potential recall errors. The authors conclude, “Our results suggest that women with a history of endometriosis and uterine fibroids might have an increased long-term risk of premature mortality extending beyond their reproductive lifespan.” They emphasize that these conditions are also linked to a heightened risk of death from gynecological cancers and that endometriosis is associated with increased non-cancer mortality.
These findings underscore the importance of primary care providers considering these gynecological disorders in their assessments of women’s health.
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