Uterine Leiomyoma is Associated with the Risk of Developing Endometriosis: A Nationwide Cohort Study Involving 156,195 Women

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Aug 26

PMID 34437644

Citations 6

Authors

Kent Yu-Hsien Lin

Chih-Yi Yang

Alan Lam

Cherry Yin-Yi Chang

Wu-Chou Lin

Affiliations

Soon will be listed here.

Abstract

Objective: Evidence for an association between uterine leiomyoma and increased risk of endometriosis is limited by small sample sizes and short follow-up periods. We assessed this association in a large nationwide sample with 14 years of data.

Design: Data were sourced from Taiwan's Longitudinal Health Insurance Database 2000 (LHID2000).

Materials And Methods: We identified 31,239 women aged ≥20 years diagnosed with uterine leiomyoma (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] code 218) between Jan 1, 2000 and Dec 31, 2012, who were matched with 124,956 controls (1:4) by 5-year age groups and year of diagnosis. Follow-up was from the date of LHID2000 entry to the first occurrence of endometriosis, loss to follow-up, insurance termination, or until December 31, 2013, whichever was earlier.

Results: In Cox regression analysis, the adjusted hazard ratio (aHR) for endometriosis in women with uterine leiomyoma was 6.44 (95% CI, 6.18, 6.72) compared with controls. The risk of endometriosis was significantly increased in women with uterine leiomyoma and comorbidities of tube-ovarian infection (aHR 2.86; 95% CI, 1.28, 6.36), endometritis (1.14; 1.06, 1.24), infertility (1.26; 1.16, 1.37), or allergic diseases (1.11; 1.05, 1.17). Having both uterine leiomyoma and endometritis significantly increased the risk of endometriosis (aHR 6.73; 95% CI, 6.07, 7.45) versus having only uterine leiomyoma (6.61; 6.33, 6.91) or endometritis (1.49; 1.31, 1.69). Similarly, having both uterine leiomyoma and infertility significantly increased the risk of endometriosis (aHR 6.95; 95% CI, 6.21, 7.78) versus having only uterine leiomyoma (6.66; 6.38, 6.96) or infertility (1.78; 1.57, 2.02).

Conclusions: A diagnosis of uterine leiomyoma appears to increase the risk of endometriosis. Patients presenting with uterine fibroids should be encouraged to give informed consent for possible simultaneous surgical treatment of endometriosis.

Citing Articles

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Endometriosis and Uterine Fibroids (Leiomyomata): Comorbidity, Risks and Implications.

Uimari O, Nazri H, Tapmeier T Front Reprod Health. 2022; 3:750018.

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References

Nezhat C, Nezhat F, Nezhat C . Endometriosis: ancient disease, ancient treatments. Fertil Steril. 2012; 98(6 Suppl):S1-62. DOI: 10.1016/j.fertnstert.2012.08.001. View

Commandeur A, Styer A, Teixeira J . Epidemiological and genetic clues for molecular mechanisms involved in uterine leiomyoma development and growth. Hum Reprod Update. 2015; 21(5):593-615. PMC: 4533663. DOI: 10.1093/humupd/dmv030. View

. Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study. Gruppo italiano per lo studio dell'endometriosi. Hum Reprod. 1994; 9(6):1158-62. View

Carter J . Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain. J Am Assoc Gynecol Laparosc. 1994; 2(1):43-7. DOI: 10.1016/s1074-3804(05)80830-8. View

Garcia-Ibanez P, Yepes-Molina L, Ruiz-Alcaraz A, Martinez-Esparza M, Moreno D, Carvajal M . Bioactives Could Ameliorate the Chronic Inflammatory Condition of Endometriosis. Int J Mol Sci. 2020; 21(24). PMC: 7763502. DOI: 10.3390/ijms21249397. View

Burney R, Talbi S, Hamilton A, Vo K, Nyegaard M, Nezhat C . Gene expression analysis of endometrium reveals progesterone resistance and candidate susceptibility genes in women with endometriosis. Endocrinology. 2007; 148(8):3814-26. DOI: 10.1210/en.2006-1692. View

Della Corte L, Noventa M, Ciebiera M, Magliarditi M, Sleiman Z, Karaman E . Phytotherapy in endometriosis: an up-to-date review. J Complement Integr Med. 2019; 17(3). DOI: 10.1515/jcim-2019-0084. View

Riemma G, Lagana A, Schiattarella A, Garzon S, Cobellis L, Autiero R . Ion Channels in The Pathogenesis of Endometriosis: A Cutting-Edge Point of View. Int J Mol Sci. 2020; 21(3). PMC: 7037987. DOI: 10.3390/ijms21031114. View

Balasch J, Creus M, Fabregues F, Carmona F, Ordi J, Martinez-Roman S . Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. Hum Reprod. 1996; 11(2):387-91. DOI: 10.1093/humrep/11.2.387. View

10.

Della Corte L, Di Filippo C, Gabrielli O, Reppuccia S, La Rosa V, Ragusa R . The Burden of Endometriosis on Women's Lifespan: A Narrative Overview on Quality of Life and Psychosocial Wellbeing. Int J Environ Res Public Health. 2020; 17(13). PMC: 7370081. DOI: 10.3390/ijerph17134683. View

11.

Uimari O, Jarvela I, Ryynanen M . Do symptomatic endometriosis and uterine fibroids appear together?. J Hum Reprod Sci. 2011; 4(1):34-8. PMC: 3136067. DOI: 10.4103/0974-1208.82358. View

12.

Bulletti C, Coccia M, Battistoni S, Borini A . Endometriosis and infertility. J Assist Reprod Genet. 2010; 27(8):441-7. PMC: 2941592. DOI: 10.1007/s10815-010-9436-1. View

13.

Maclaran K, Agarwal N, Odejinmi F . Co-existence of uterine myomas and endometriosis in women undergoing laparoscopic myomectomy: risk factors and surgical implications. J Minim Invasive Gynecol. 2014; 21(6):1086-90. DOI: 10.1016/j.jmig.2014.05.013. View

14.

Peterson C, Johnstone E, Hammoud A, Stanford J, Varner M, Kennedy A . Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. Am J Obstet Gynecol. 2013; 208(6):451.e1-11. PMC: 4114145. DOI: 10.1016/j.ajog.2013.02.040. View

15.

Wise L, Laughlin-Tommaso S . Epidemiology of Uterine Fibroids: From Menarche to Menopause. Clin Obstet Gynecol. 2016; 59(1):2-24. PMC: 4733579. DOI: 10.1097/GRF.0000000000000164. View

16.

Ling F . Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol. 1999; 93(1):51-8. DOI: 10.1016/s0029-7844(98)00341-x. View

17.

Garzon S, Lagana A, Barra F, Casarin J, Cromi A, Raffaelli R . Aromatase inhibitors for the treatment of endometriosis: a systematic review about efficacy, safety and early clinical development. Expert Opin Investig Drugs. 2020; 29(12):1377-1388. DOI: 10.1080/13543784.2020.1842356. View

18.

Stewart E . Uterine fibroids. Lancet. 2001; 357(9252):293-8. DOI: 10.1016/S0140-6736(00)03622-9. View

19.

Giudice L, Kao L . Endometriosis. Lancet. 2004; 364(9447):1789-99. DOI: 10.1016/S0140-6736(04)17403-5. View

20.

Borah B, Nicholson W, Bradley L, Stewart E . The impact of uterine leiomyomas: a national survey of affected women. Am J Obstet Gynecol. 2013; 209(4):319.e1-319.e20. PMC: 4167669. DOI: 10.1016/j.ajog.2013.07.017. View