In 2019, non-communicable diseases (NCDs) accounted for 15.6 million deaths among individuals aged 30 to 69, representing 76% of all premature deaths. Identifying risk factors for these diseases, particularly cancer, cardiovascular disease (CVD), and respiratory illnesses, is critical. While lifestyle factors such as smoking, poor diet, and obesity contribute to premature mortality, recent studies suggest that reproductive health conditions may also play a significant role.
Endometriosis and uterine fibroids affect approximately 10% and 15-30% of women of reproductive age, respectively. These conditions share genetic characteristics and involve similar immunologic, hormonal, and inflammatory pathways. Women suffering from these disorders are at heightened risk for CVD, hypertension, and various cancers.
The recent study analyzed data from the Nurses Health Study II, which tracked the health of 110,091 women in the United States from 1989 to 2019. At the study’s outset, participants were aged 25 to 42 and had no history of hysterectomy, endometriosis, fibroids, CVD, or cancer. Over the course of the study, researchers assessed the risk of total and condition-specific premature mortality in women diagnosed with endometriosis or fibroids.
Women with endometriosis exhibited a significantly higher infertility rate of 52%, compared to 16% among those without the condition. Additionally, 21% of women with endometriosis underwent hysterectomies, and 17% had oophorectomies, compared to just 1% of women without endometriosis. Furthermore, 32% of women with endometriosis were prescribed hormone replacement therapy (HRT), compared to 9% of those without the condition.
Uterine fibroids were associated with a 27% infertility rate and a similar trend in surgical interventions, with 20% undergoing hysterectomy and 10% oophorectomy.
The study followed participants for a total of 2,994,354 person-years, averaging 27.2 years per woman. A total of 1,459 premature deaths were recorded, primarily due to cancer, followed by CVD and respiratory diseases. The analysis found that premature mortality rates were significantly higher among women with endometriosis—2 deaths per 1,000 person-years compared to 1.4 for those without the condition. After adjusting for confounding factors, the risk of early death was found to be 19% higher for women with endometriosis and 31% higher when other factors were considered.
Specifically, non-cancerous respiratory diseases doubled the risk of premature death, while nervous system disorders increased the risk by 2.5-fold. Women with endometriosis were 2.76 times more likely to develop female reproductive tract cancers.
The study concluded that endometriosis and uterine fibroids increased the risk of female reproductive tract cancers by 34% and 28%, respectively. Women with both conditions faced a 61% higher risk of CVD, and those with isolated endometriosis had a 93% increased risk. Interestingly, while uterine fibroids did not elevate overall premature mortality risk, they were associated with a 2.32-fold increased risk of death from gynecological cancers.
Previous studies have often overlooked confounding factors such as hormone use, infertility, and health behaviors when assessing the risk of premature death in women with endometriosis and fibroids. Variations in diagnostic practices and access to treatment may also explain discrepancies between past findings and the current study. Nevertheless, several studies align with these new findings, establishing a connection between endometriosis, fibroids, and increased gynecologic cancer risk.
Conclusion
The findings suggest that women with endometriosis and uterine fibroids may face a higher risk of premature death, particularly from gynecological cancers, even after their reproductive years. Moreover, endometriosis is linked to increased mortality from non-cancer causes. The interaction between endometriosis and fibroids appears to create distinct mortality risks, underscoring the need for further research into the underlying mechanisms and the development of preventive and therapeutic strategies.
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