Women with endometriosis and uterine fibroids may have a slightly increased risk of premature death in the long term, according to a large analysis of more than 100,000 American nurses from the Nurses’ Health Study II cohort, followed over several decades. Gynecological cancers are particularly involved, but not only that. Endometriosis is also associated with excess mortality linked to senility, respiratory diseases and diseases of the nervous system and sensory organs.
The study published in the BMJ looked at data from 110,091 women aged 25 to 42 in 1989. Beginning in 1993 and every two years thereafter, these women reported any confirmed diagnosis of endometriosis and uterine fibroids. During the 30 years of follow-up, 4,356 premature deaths (before age 70) were recorded, including 1,459 due to cancer, 304 to cardiovascular diseases and 90 to respiratory diseases. The crude incidence of premature all-cause mortality in women with and without endometriosis was 2.01 and 1.40 per 1,000 person-years, respectively.
Risk of premature mortality increased by 31% for endometriosis
After adjusting for age, endometriosis was associated with a 19% increased risk of early death. And, after adjusting for a set of confounding factors (body mass index, diet, physical activity, smoking, etc.), the risk turns out to be increased by 31%, mainly due to gynecological cancers.
In detail, analyzes of mortality by specific cause show associations with senility and poorly defined diseases (HR = 1.80), non-malignant respiratory diseases (HR = 1.95), diseases of the nervous system and sensory organs (HR = 2.50) and malignant neoplasms of gynecological organs (HR = 2.76).
However, no increased risk of premature mortality from all causes is observed in patients with uterine fibroids. This pathology is, however, associated, in analyzes of mortality by specific cause, with an increased risk of mortality linked to gynecological cancer (HR = 2.32).
“Risk of mortality from cardiovascular and respiratory diseases varied across endometriosis and uterine fibroid categories, with increased risk of premature mortality from all causes among women reporting both endometriosis and uterine fibroids,” the authors also point out.
Underlying mechanisms still to be elucidated
Several explanatory hypotheses are put forward. Regarding cancer mortality, “common mechanistic pathways”such as hyperestrogenism, oxidative stress and inflammation, could contribute to both these gynecological diseases and cancer mortality. Common genetic factors could also be at play.
For mortality due to respiratory diseases, senility or diseases of the nervous system, the hypotheses “are less simple to issue”recognize the authors. They highlight recent data on the health of women with endometriosis, who are more likely to develop long and severe forms of Covid, but also to present asthma and allergies. “These data could support pathways by which greater premature mortality from respiratory diseases is plausible”they estimate. Mortality from nervous system disease could be partly explained by neuroinflammation and an increased risk of nociplastic pain and conditions linked to multisystem pain observed in women with endometriosis, continue the authors.
If studies are necessary to confirm the results and explore the mechanisms at work, the authors already encourage doctors who follow these patients, in particular general practitioners, to take these observations into account in their care.
