Endometriosis and uterine fibroids are associated with a risk of premature death.

Important points:

• Having a history of endometriosis alone or both endometriosis and uterine fibroids increases the risk of premature death.
• PCPs should consider both conditions when evaluating a woman's health.

Women with a history of endometriosis or uterine fibroids may be at higher risk of premature death, according to the results of a retrospective cohort study. of BMJ suggest.

The findings “highlight the need for primary care providers to assess these two gynecological conditions in parallel when assessing women's health.” Wang YixingDoctor of Medicine, A professor of environmental health at the School of Public Health at Shanghai Jiao Tong University told Helio. “Standard precautions and screening should be considered for patients with a history of either condition to reduce long-term health risks.”

both endometriosis Uterine fibroids are also associated with chronic diseases such as hypertension, CVD, and cancer, but their impact on mortality under age 70 remains unclear, Wang et al. write.

“Additionally, the impact of the co-occurrence of endometriosis and uterine fibroids needs to be evaluated,” the researchers added.

Researchers looked at data from a cohort of 110,091 women who were 25 to 42 years old in 1989 in the Nurses' Health Study II and had no history of endometriosis or prior hysterectomy. I considered it. Diagnosis of uterine fibroidscancer or CVD.

Participants began reporting whether they had laparoscopically confirmed endometriosis or uterine fibroids confirmed by ultrasound or hysterectomy in 1993 and every two years thereafter.

During the 30-year follow-up period, there were 4,356 premature deaths, including 1,459 from cancer, 304 from CVD, and 90 from respiratory disease.

All-cause early mortality rates for women with and without confirmed endometriosis were 2.01 and 1.4 per 1000 person-years, respectively.

Wang et al. found that endometriosis increased the risk of early all-cause mortality by 31% (HR = 1.31, 95% CI, 1.2-1.44) after adjusting for behavioral factors such as age, BMI, physical activity, and smoking. was found to be equivalent to

Endometriosis also increases the risk of death from several causes, including death from:

• non-malignant respiratory disease (HR = 1.95; 95% CI, 1.11-3.41);
• malignant neoplasm of gynecological organs (HR = 2.76; 95% CI, 1.79-4.26).
• diseases of the nervous system and sense organs (HR = 2.5; 95% CI, 1.4-4.44); and
• geriatric and unspecified disease (HR = 1.8; 95% CI, 1.19-2.73).

Although uterine fibroids did not increase the risk of early death from all causes, they were associated with a higher risk of death from gynecological cancers (HR = 2.32; 95% CI, 1.59-3.4).

Women who reported both endometriosis and uterine fibroids had an increased risk of early all-cause death (HR = 1.31; 95% CI, 1.12-1.53).

Those with both conditions also had a higher risk of dying from CVD (HR = 1.61; 95% CI, 0.93-2.76) “despite the confidence interval being above the null value,” the researchers said. is writing.

“This finding suggests that endometriosis may interact synergistically with uterine fibroids to accelerate the risk of cardiovascular mortality in later life,” the researchers wrote. .

The observed association between cancer mortality, endometriosis, and uterine fibroids suggests that “common mechanistic pathways (e.g., hyperestrogenism, oxidative may reflect stress, inflammation),” Wang et al.

The researchers acknowledged some limitations to the study. Both uterine fibroids and endometriosis were self-reported, which could lead to misclassification, but over 90% of the cohort were non-Hispanic white women, which compromises the generalizability of the results. Ta.

Wang highlighted several directions in which future research could go.

“First, given that the studied cohorts are largely homogeneous, replicating these findings in diverse populations is critical to increasing generalizability,” she explained. . “Second, although this study establishes an association between endometriosis, uterine fibroids, and early death, it is difficult to elucidate the underlying biological mechanisms and develop effective prevention strategies. Further research is needed.”

Ultimately, “women with endometriosis or uterine fibroids should not be unduly alarmed by these findings and should be encouraged to regularly monitor their health and take preventive measures.” said Mr. Wang.