Association between early life abuse and risk of endometriosis

Background: Endometriosis affects about 10% of all reproductive-aged women, with signs and symptoms that include chronic pelvic pain and infertility. Retrograde menstruation and increased exposure to menstrual flow (lower parity, short menstrual cycle interval, earlier menarche, lean body mass) have been identified as risk factors for endometriosis. Abuse during childhood and adolescence is a significant and major health problem in developing and industrialized countries, with the Centers for Disease Control of the United States recognizing child abuse and neglect as childhood stressors that impact long term health and could play a role in the etiology and/or clinical signs of endometriosis through influences on inflammation, menstrual cycle characteristics or chronic pelvic pain Methods: In most of the recent studies, Prospective cohort study using data collected and participants completed an exposure to violence victimization questionnaire, demographic and lifestyle questionnaire. Cases were restricted to laparoscopically-confirmed endometriosis. Participants were excluded if they reported a history of endometriosis, infertility or cancer (other than non-melanoma skin cancer) before cohort baseline Results: Severity of physical abuse, sexual abuse and the CTQ score were positively associated with the incidence of endometriosis in a dose–response manner. Both physical and sexual abuse history were associated with a higher incidence of endometriosis compared to those who never reported abuse. The associations between abuse and endometriosis were stronger among women presenting without infertility, a group that was more likely to have been symptomatic with respect to pain. In the fully adjusted model, we observed an increased risk of endometriosis with exposure to physical abuse only (HR, 1.10; 95% CI, 1.01–1.20) and sexual abuse only (HR, 1.15; 95% CI, 1.03–1.30). The highest risk of endometriosis was observed among women with a combination of physical and sexual abuse history (HR, 1.31; 95% CI 1.19–1.45)Conclusion: Early life sexual and physical abuse was associated with an increased risk of endometriosis. Severity, chronicity and accumulation of types of abuse were associated with greater risk. Understanding the mechanisms underlying these relations may better define the biologic impacts of abuse and the related athophysiology of endometriosis. Abuse may be associated with some but not all gynecologic disorders with neuroendocrine-inflammatory origin. High prevalence of abuse reporting supports the need for care providers to screen for abuse and initiate appropriate follow-up

Keywords:

Endometriosis , abuse , early life , maltreatment