Endometriosis risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Joseph Nasr, M.D.[2] Aravind Kuchkuntla, M.B.B.S[3]

## Overview

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Risk factors predisposing women to the development of endometriosis include early age at menarche, nulliparity, positive family history, and the presence of congenital cervical stenosis or obstructive lesions in the uterovaginal tract. Additional epidemiologic risk factors include short menstrual cycle length, lower body mass index, and obstructive Müllerian anomalies.[1][2]

Twin studies estimate the heritability of endometriosis to be approximately 50%.[3]

## Risk Factors

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The risk factors predisposing women to develop endometriosis include the following:[4][5]

* Presence of cervical stenosis and other congenital outflow obstructions (leads to the retrograde efflux of the menstrual fluid into the fallopian tubes and peritoneal cavity); among individuals with obstructive Müllerian anomalies, the prevalence of endometriosis is 47% (95% CI, 36%–58%).[1]
* Caffeine or alcohol use
* First-degree family relative with endometriosis (relative risk among sisters 5.2; 95% CI, 3.4–7.2).[6][7]
* Nulliparity (associated with increased risk; pregnancy may be protective due to prolonged anovulation).[8]
* Menarche before 12 years of age (associated with increased risk).[2]
* Short menstrual cycle length (<28 days), associated with increased risk.[9]
* Lower body mass index (associated with increased risk).[10]
* Tall stature
* Genetic susceptibility with estimated heritability of approximately 50%.[11]

## References

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1. ↑ 1.0 1.1 Vercellini P, Salmeri N, Somigliana E, et al. Müllerian anomalies and endometriosis as potential explanatory models for the retrograde menstruation/implantation and the embryonic remnants/celomic metaplasia pathogenic theories: a systematic review and meta-analysis. Hum Reprod. 2024;39(7):1460-1470. doi:10.1093/humrep/ deae086
2. ↑ 2.0 2.1 LuMY, Niu JL, Liu B. The risk of endometriosis by early menarche is recently increased: ameta-analysis of literature published from 2000 to 2020. Arch Gynecol Obstet. 2023;307(1):59-69. doi:10.1007/s00404-022-06541-0
3. ↑ Saha R, Pettersson HJ, Svedberg P, et al. Heritability of endometriosis. Fertil Steril. 2015;104(4):947-952. doi:10.1016/j.fertnstert.2015.06.035
4. ↑ Thomsen LH, Schnack TH, Buchardi K, Hummelshoj L, Missmer SA, Forman A; et al. (2017). "Risk factors of epithelial ovarian carcinomas among women with endometriosis: a systematic review". Acta Obstet Gynecol Scand. 96 (6): 761–778. doi:10.1111/aogs.13010. PMID 27565819.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
5. ↑ Lassus H, Pasanen A, Bützow R (2015). "[Is endometriosis a premalignant condition to ovarian carcinoma?]". Duodecim. 131 (19): 1777–84. PMID 26638662.CS1 maint: Multiple names: authors list (link)
6. ↑ Cramer DW, Missmer SA (2002). "The epidemiology of endometriosis". Ann N Y Acad Sci. 955: 11–22, discussion 34-6, 396–406. PMID 11949940.
7. ↑ Stefansson H, Geirsson RT, Steinthorsdottir V, et al. Genetic factors contribute to the risk of developing endometriosis. Hum Reprod. 2002;17(3):555-559. doi:10.1093/humrep/17.3.555
8. ↑ Missmer SA, Hankinson SE, Spiegelman D, et al. Reproductive history and endometriosis among premenopausal women. Obstet Gynecol. 2004;104 (5 Pt 1):965-974. doi:10.1097/01.AOG.0000142714.54857.f8
9. ↑ Wei M, Cheng Y, Bu H, Zhao Y, ZhaoW. Length of menstrual cycle and risk of endometriosis: a meta-analysis of 11 case-control studies. Medicine(Baltimore). 2016;95(9):e2922. doi:10.1097/MD.0000000000002922
10. ↑ Liu Y, ZhangW. Association between body mass index and endometriosis risk: ameta-analysis. Oncotarget. 2017;8(29):46928-46936. doi:10.18632/oncotarget.14916
11. ↑ Treloar SA, O’Connor DT, O’Connor VM, Martin NG. Genetic influences on endometriosis in an Australian twin sample. Fertil Steril. 1999;71(4):701-710. doi:10.1016/S0015-0282(98)00540-8