Concurrent endometriosis, uterine fibroids linked to risk for premature death

Key takeaways:

• Endometriosis alone or a history of both endometriosis and uterine fibroids increased the risk for premature death.
• PCPs should consider both conditions when assessing women’s health.

Women with a history of endometriosis and uterine fibroids may be at a greater risk for premature death, results from a retrospective cohort study published in The BMJ suggest.

The findings “emphasize the need for primary care providers to assess these two gynecological disorders in tandem when evaluating women’s health,” Yi-Xin Wang, MD, professor of environmental health at Shanghai Jiao Tong University School of Public Health in Shanghai, told Healio. “Standard preventive measures and screenings should be considered for patients with a history of either condition to mitigate long-term health risks.”

Both endometriosis and uterine fibroids have been tied to chronic diseases like hypertension, CVD and cancer, but their effect on death before age 70 years remains uncertain, Wang and colleagues wrote.

“Additionally, the influence of the co-occurrence of endometriosis and uterine fibroids needs to be assessed,” they added.

The researchers examined data from a cohort of 110,091 women from the Nurses’ Health Study II who were aged 25 to 42 years in 1989 and had no history of hysterectomy before endometriosis or fibroids diagnosis, cancer or CVD.

Participants began reporting whether they had laparoscopy-confirmed endometriosis or ultrasound- or hysterectomy-confirmed uterine fibroids in 1993 and every 2 years after.

There were 4,356 premature deaths, including 1,459 from cancer, 304 from CVD and 90 from respiratory diseases, during a follow-up period of 30 years.

The rate of all-cause premature death among women with and without confirmed endometriosis was 2.01 and 1.4 per 1,000 person years, respectively.

Wang and colleagues found that endometriosis corresponded with a 31% increased risk for premature death (HR = 1.31; 95% CI, 1.2-1.44) from all causes after they adjusted for age and behavioral factors like BMI, physical activity and smoking.

Endometriosis also increased the risk for several cause-specific deaths, including deaths from:

• nonmalignant respiratory diseases (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
• senility and ill-defined diseases (HR = 1.8; 95% CI, 1.19-2.73).

Uterine fibroids did not increase the risk for premature death from all causes but showed a link to a higher risk for death from gynecologic cancers (HR = 2.32; 95% CI, 1.59-3.4).

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

Those with both conditions also had a greater risk for death from CVD (HR = 1.61; 95% CI, 0.93-2.76), “albeit the confidence interval crossing the null value,” the researchers wrote.

“This finding suggests that endometriosis might interact synergistically with uterine fibroids, possibly accelerating the risk of cardiovascular disease mortality in later life,” they wrote.

The observed associations between cancer mortality, endometriosis and uterine fibroids “might reflect shared mechanistic pathways (eg, hyperestrogenism, oxidative stress, and inflammation) that synergistically contribute to these gynecological diseases and cancer mortality,” Wang and colleagues wrote.

The researchers acknowledged some study limitations. Both uterine fibroids and endometriosis were self-reported — possibly resulting in misclassification — while more than 90% of the cohort were non-Hispanic white women, thus hurting the generalizability of the findings.

Wang highlighted a few directions that future research could take.

“First, given the largely homogenous cohort studied, replicating these findings in diverse populations is crucial to enhance their generalizability,” she explained. “Second, while this study establishes an association between endometriosis, uterine fibroids, and premature mortality, further research is needed to elucidate the underlying biological mechanisms and to develop effective preventive strategies.”

Ultimately, “women with endometriosis or uterine fibroids should not be unduly alarmed by these findings but should instead be encouraged to seek regular health monitoring and adopt preventive measures,” Wang said.