Although endometriosis is common, relatively few studies have examined its potential association with early natural menopause (ENM). A team of researchers sought to address this shortcoming and published their findings in JAMA.3

Endometriosis affects approximately 2 to 10 percent of women aged 25 to 40 years in the United States.1 The condition, in which tissue resembling the lining of the uterus builds up outside the uterus, can lead to pelvic pain, excessive bleeding, and impaired fertility, among other complications.2

Researchers Examined Data From a Large Cohort

Early menopause has been linked with a reduced reproductive span, early mortality, and cardiovascular disease risk, among other health concerns. Despite these adverse outcomes, relatively little is known about a possible association between endometriosis and menopausal timing. The researchers noted that, to their knowledge, “no previous study has prospectively investigated the association between endometriosis and ENM with time-varying covariates, time-to-event analyses, and early age at natural menopause.”


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The investigators examined the link between laparoscopically confirmed endometriosis and ENM by analyzing questionnaires from the Nurses’ Health Study II cohort between 1989 and 2015. In the questionnaires, the women were asked whether they had been diagnosed with endometriosis or gone through the menopause transition, among other queries. They were followed until they began menopause, reached 45 years of age, underwent a hysterectomy or oophorectomy, received a cancer diagnosis, died, stopped responding to the survey, or arrived at the end of the follow-up period in May 2017. In all, the researchers examined 106,633 premenopausal women with a mean age of 34.8 years at baseline.

Investigators Found a Link, But Results Need Strengthening

The researchers found that laparoscopically confirmed endometriosis was associated with a 50% greater risk for early menopause. They observed a similar, likewise elevated risk after adjusting for race, time-varying anthropometric factors, and behavioral factors. Women who had never given birth and who had never used oral contraceptives were especially at risk for shorter reproductive duration.

The investigators noted, however, that their findings need to be supported in a more diverse group of women. The Nurses’ Health study lacks diversity, as the group is over 95% non-Hispanic white and doesn’t represent the diversity of the U.S. population.

Takeaway

The researchers concluded that they found a “statistically significant association” between laparoscopically confirmed endometriosis and risk for ENM.” They continued, “endometriosis may be an important risk factor for ENM, and women with endometriosis, particularly those who are nulliparous and never-users of OCs, may be at a higher risk for a shortened reproductive duration.”

References

1. Endometriosis. Johns Hopkins Medicine. Accessed January 31, 2022.

2. Endometriosis. Mayo Clinic. July 24, 2018. Accessed January 31, 2022.

3. Kulkarni MT, Shafrir A, Farland LV, et al. Association between laparoscopically confirmed endometriosis and risk of early natural menopause. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788287. JAMA Netw Open. 2022 Jan 4;5(1):e2144391. Doi: 10.1001/jamanetworkopen.2021.44391.