Endometriosis is associated with a 31% higher risk of early death, and the mortality rate from gynecological cancers, nervous system diseases, and respiratory conditions has increased.
Endometriosis and uterine fibroids are gynecological conditions that affect women of reproductive age. A recent study published in The BMJ explored the impact of these disorders on the risk of early death.
In 2019, non-communicable diseases (NCDs) accounted for 15.6 million premature deaths among individuals aged 30 to 69 years, accounting for 76% of all premature deaths. Therefore, it is crucial to identify the risk factors for these deaths, especially those related to cancer, cardiovascular disease (CVD), and respiratory diseases.
Smoking, poor diet, and excessive body weight contribute to the risk of premature death. However, recent research has also indicated that female-specific traits related to the menstrual cycle and pregnancy also play a role in premature death.
Endometriosis and uterine fibroids affect 10% and 15% – 30% of women of reproductive age respectively. These conditions have similar genetic characteristics and often involve shared immunological, hormonal, and inflammatory pathways.
Women with these conditions are more likely to die prematurely and have a higher risk of cardiovascular disease, hypertension, and cancer. Despite these observations, few studies have examined how these conditions and certain health factors such as behaviors, hormone replacement therapy (HRT) or oral contraceptive use, hysterectomy or oophorectomy, infertility history, or the risk of both concurrent conditions may further contribute to the increased risk of premature mortality.
The current study analyzed the impact of endometriosis and uterine fibroids on the risk of premature mortality among women over a 30-year period. The aim of this study was to assess the total and condition-specific risks of premature mortality in women with either or both of these conditions confirmed by ultrasound, laparoscopy, or hysterectomy.
Information was collected through questionnaires every two years starting from 1993.The current prospective cohort study used data obtained from the Nurses’ Health Study II, which was conducted in the United States from 1989 to 2019. In 1989, 110,091 women aged between 25 and 42 were recruited.None of these women had a history of hysterectomy, endometriosis, fibroids, CVD, or cancer at baseline.
The average age of the participants was 34.7 years in 1989 and 64.4 years in 2019, at which point most of the women had experienced menopause.”Viva Saliva Book: The Ultimate Guide to Saliva” Book preview Download eBook Compilation of the top interviews, articles, and news in the last year.
Women with endometriosis were more likely to be infertile, with an infertility rate of 52%, compared to 16% for women without this condition. Furthermore, women with endometriosis were more likely to have undergone a hysterectomy and oophorectomy, with the proportions being 21% and 17% respectively, compared to 1% for women without endometriosis.
Women diagnosed with endometriosis were more likely to use non-steroidal anti-inflammatory drugs (NSAIDs) other than aspirin, with a proportion of 28%, compared to 19% for women not diagnosed with endometriosis. Hormone replacement therapy (HRT) was also prescribed to 32% of women with endometriosis, compared to 9% for non-endometriosis women.
Uterine fibroids were associated with an infertility prevalence of 27%, compared to 18% for those without fibroids. Women with uterine fibroids were also more likely to undergo a hysterectomy and oophorectomy, with the proportions being 20% and 10% respectively, compared to 1% for women without uterine fibroids.
These women were followed up for a total of 2,994,354 person-years (PY), with an average follow-up of 27.2 years per woman. Premature deaths were defined as deaths occurring in women younger than 70 years of age. A total of 1,459 premature deaths were due to cancer, followed by 304 due to CVD and 90 due to respiratory disease.
Among women with endometriosis, there were 2 premature deaths per 1,000 PY, compared to 1.4 for women without endometriosis. The age-adjusted risk of early death was 19% higher in women with endometriosis and 31% higher after adjusting for other confounding factors.
Non-cancerous respiratory diseases doubled the risk of premature mortality, while disorders of the nervous system or sense organs increased the risk by 2.5 times. Women with endometriosis were 2.76 times more likely to develop female reproductive tract cancers.
Endometriosis and uterine fibroids increased the risk of female reproductive tract cancers by 34% and 28% respectively, and when both conditions were present, the associated risk increased by 20%. Among women with both disorders, the risk of CVD was 61% higher compared to a 93% increased risk with isolated endometriosis and there was no increase in the risk for fibroids alone.
Overall, the presence of uterine fibroids did not increase the risk of premature death. However, fibroids were associated with a 2.32-fold increased risk of premature death from gynecological cancers.
The risks of CVD and respiratory diseases in premature mortality varied, and both were higher when endometriosis and fibroids were present. Endometriosis was also associated with a 2.2-fold greater risk of premature death from respiratory causes.
Previous studies failed to consider confounding factors such as hormone use, infertility, or health behaviors on the risk of premature death in women with endometriosis and/or uterine fibroids. Diagnostic biases, differences due to population characteristics, and differences in access to treatment may also have contributed to the differences between the current study findings and previous reports.
Nevertheless, several studies have produced findings that are consistent with the current analysis. These studies have also identified associations between endometriosis and fibroids and a higher risk of gynecological cancer.
