Endometriosis linked with increased risk of premature death
Data from the Nurses' Health Study showed that patients with endometriosis and uterine fibroids had greater long-term risk of premature mortality, driven primarily by malignant neoplasm of gynecological organs.
Endometriosis and uterine fibroids are associated with an increased risk of premature death that extends beyond women's reproductive lifespan, a prospective cohort study found.
Using data from the U.S. Nurses' Health Study II, researchers assessed the long-term risk of premature mortality (before age 70 years) among 110,091 women ages 25 to 42 years in 1989. All participants had no history of cardiovascular disease, cancer, or hysterectomy before endometriosis or fibroids diagnosis. Average participant age was 34.7 years in 1989 and 64.4 years in 2019. Findings were published by The BMJ on Nov. 20.
There were a total of 4,356 premature deaths during 2,994,354 person-years of follow-up (27.2 years per person). Of these deaths, 1,459 were from cancer, 304 were from cardiovascular diseases, and 90 were from respiratory diseases. Before adjustment, incidence of all-cause premature death for women with or without endometriosis was 2.01 versus 1.40 per 1,000 person-years, respectively. After adjustment for age, endometriosis was associated with a hazard ratio (HR) of 1.19 (95% CI, 1.09 to 1.30) for premature death. The risk increased even more after adjustment for potential confounders, including behavioral factors (HR, 1.31; 95% CI, 1.20 to 1.44). The association between endometriosis and premature death was largely driven by senility and ill-defined diseases (HR, 1.80; 95% CI, 1.19 to 2.73), nonmalignant respiratory diseases (HR, 1.95; 95% CI, 1.11 to 3.41), diseases of the nervous system and sense organs (HR, 2.50; 95% CI, 1.40 to 4.44), and malignant neoplasm of gynecological organs (HR, 2.76; 95% CI, 1.79 to 4.26). Endometriosis was also linked with a greater risk of death from cancer (HR, 1.22; 95% CI, 1.04 to 1.44) and respiratory diseases (HR, 1.95; 95% CI, 1.11 to 3.41).
Uterine fibroids were not associated with a significant increase in all-cause premature death (HR, 1.03; 95% CI, 0.95 to 1.11). However, they were linked with a greater risk of death from malignant neoplasm of gynecological organs (HR, 2.32; 95% CI, 1.59 to 3.40). Women with both endometriosis and uterine fibroids had an increased risk of all-cause premature death (HR, 1.31; 95% CI, 1.12 to 1.53).
Limitations to the study include that endometriosis and uterine fibroids were self-reported and that more than 90% of participants were non-Hispanic White, potentially limiting generalizability.
Researchers hypothesized that shared genetic factors and mechanistic pathways may partially account for the association of uterine fibroids and endometriosis with cancer. Overall, the findings highlight the need for primary care clinicians to consider these gynecological disorders in their assessment of women's health, the authors concluded.