By Laurie Barclay, M.D.
A cross-sectional survey reported in the Sept. 27 (2002) issue of Human Reproduction showed that women with endometriosis have higher rates of autoimmune and other chronic diseases than do women in the general U.S. population.
"Women with endometriosis frequently suffer from autoimmune inflammatory diseases, hypothyroidism, fibromyalgia (FM), chronic fatigue syndrome (CFS), allergies and asthma," lead author Ninet Sinaii, from the National Institute of Child Health and Human Development in Bethesda, Maryland, says in a news release. "These findings also suggest a strong association between endometriosis and autoimmune disorders and indicate the need to consider the co-existence of other conditions in women with endometriosis."
In this population-based survey of 3,680 members of the Endometriosis Association, all had surgically diagnosed endometriosis, 90% were of reproductive age, 66% had a positive family history for diagnosed or suspected endometriosis, and 20% had more than one other chronic disease. Nearly one-third of those with coexisting diseases also had been diagnosed with either FM or CFS, and some of these women also had other autoimmune or endocrine disease.
Compared with expected rates in the general population of U.S. women, women in this survey had increased rates of chronic disease. CFS was more than a hundred times more common (4.60% vs. 0.03%, P<.0001), hypothyroidism seven times more common (9.6% vs. 1.5%, P<.0001), and FM was nearly twice as common (5.9% vs. 3.4%, P<.0001).
Women with endometriosis also had higher than expected rates of autoimmune inflammatory diseases including systemic lupus erythematosus, Sjögren's syndrome, and rheumatoid arthritis, as well as multiple sclerosis. Allergies occurred in 61% (vs. 18%; P<.001) and asthma in 12% (vs. 5%; P<.001) of survey subjects overall. Of those subjects who also had FM or CFS, 88% had allergies (P<.001) and 25% had asthma (P<.001).
"As well as finding an increased prevalence of this wide range of diseases and conditions among women with endometriosis, we found that they reported significant pain and disability and, very worryingly, that there was typically a 10-year delay between the onset of pelvic pain and diagnosis," Sinaii says.
Potential study limitations included the subjects being relatively young, predominantly white, well-educated, and members of a support group. However, sensitivity analysis confirmed that even if chronic disease prevalence rates were underestimated in the general population and overestimated in the survey, the rates reported in women with endometriosis were still significantly higher.
"Since women appear to develop symptoms shortly after the onset of their periods and are not diagnosed for years, we don't know whether endometriosis actually occurs at menarche as others have reported or whether it develops over time," senior author Pamela Stratton says. "It's also unclear whether early treatment could prevent chronic pelvic pain from taking hold. It is vital therefore that attempts should be made to diagnose and treat endometriosis in adolescents."
Hum Reprod. 2002;17(10):2715-2724
Reviewed by Gary D. Vogin, M.D.