1. A history of endometriosis and uterine fibroids in women was associated with a greater risk of premature mortality and mortality due to gynecological cancers.

2. A history of endometriosis in women was associated with a greater risk of non-cancer mortality. 

Evidence Rating Level: 2 (Good)

Endometriosis and uterine fibroids are common disorders among women of reproductive age which have previously been shown to be associated with increased risks of cardiovascular disease, hypertension and cancer. However, the associations between endometriosis and uterine fibroids and subsequent mortality risk as well as the impact of co-occurrence of the two disorders have not been well characterized. This prospective cohort study therefore sought to investigate the effect of endometriosis and uterine fibroids on the long-term risk of premature mortality in women living in the United States. Female nurses living in the United States between the ages of 25-42 were identified as part of the Nurses’ Health Study II ongoing prospective cohort. Women were excluded if they had a prior history of cardiovascular disease or cancer before enrollment or had a hysterectomy prior to diagnosis of endometriosis or uterine fibroids. Overall, 110,091 women (mean age in 1989, 34.7±4.7 years; mean age in 2019, 64.4±4.7 years) were enrolled in the study and received questionnaires until death or end of follow-up in June 2019, with deaths under the age of 70 years being defined as premature deaths. When adjusted for potential confounders, laparoscopically-confirmed endometriosis was associated with a hazard ratio (HR) of 1.31 (95% confidence interval (CI) 1.20 to 1.44) for premature death, with an HR for cancer of 1.22 (95% CI, 1.04 to 1.44) and an HR for respiratory diseases of 1.95 (95% CI, 1.11 to 3.41). Uterine fibroids were not associated with all-cause premature mortality (HR, 1.03; 95% CI, 0.95 to 1.11). When jointly categorizing participants based on occurrence of endometriosis and uterine fibroids, an increased risk of total mortality was observed in women reporting endometriosis only (HR, 1.32; 1.19 to 1.47) as well as women reporting endometriosis and uterine fibroids (HR, 1.31; 95% CI, 1.12 to 1.53). Overall, this study found a history of endometriosis and uterine fibroids was associated with a greater risk of premature mortality and that endometriosis was associated with a greater risk of non-malignant mortality. 

Click to read the study in BMJ

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