A major U.S. study has found that women diagnosed with endometriosis or uterine fibroids face a higher risk of premature death—especially from cancer and respiratory diseases. Conducted over three decades, this research highlights the long-term health risks linked to two of the most common gynecological conditions.
Study Overview
The findings come from the Nurses’ Health Study II, a large and long-running investigation into women’s health in the United States. The study began in 1989 and followed 110,091 women aged 25 to 42 over 30 years. All participants were free of hysterectomy, cancer, cardiovascular disease (CVD), endometriosis, and fibroids at the start of the study.
By 2019, the average participant age had risen to 64.4, with most women having gone through menopause. The researchers analyzed health data collected every two years, including confirmed diagnoses of endometriosis and fibroids via ultrasound, laparoscopy, or hysterectomy.
High Rates of Infertility and Surgery
Women with endometriosis or fibroids were more likely to struggle with infertility and undergo invasive procedures.
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Infertility affected 52% of women with endometriosis, compared to 16% without the condition.
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Hysterectomy and oophorectomy (removal of the uterus and ovaries) were far more common among these women:
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21% of women with endometriosis had hysterectomies vs. 1% of those without.
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17% had oophorectomies vs. 1% of non-endometriosis participants.
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Women with fibroids also had elevated surgery rates:
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20% had hysterectomies and 10% had oophorectomies.
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Medication Use
Endometriosis was linked to higher use of medications like:
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Non-steroidal anti-inflammatory drugs (NSAIDs) (excluding aspirin): 28% of women with endometriosis used them, compared to 19% without.
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Hormone Replacement Therapy (HRT): Used by 32% of women with endometriosis, compared to just 9% of others.
Premature Death Rates
Researchers tracked 2,994,354 person-years over an average of 27.2 years per participant. Premature deaths were defined as those occurring before age 70.
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Total premature deaths: 1,459 from cancer, 304 from CVD, and 90 from respiratory diseases.
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Among women with endometriosis, the rate of early death was 2 per 1,000 person-years, versus 1.4 per 1,000 among those without.
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After adjusting for age and other factors, the risk of premature death was:
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19% higher in women with endometriosis (age-adjusted).
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31% higher when adjusted for confounding variables.
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Specific Causes of Death
The study found alarming patterns in cause-specific mortality:
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Respiratory disease doubled the risk of premature death.
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Neurological or sensory system disorders raised the risk by 2.5 times.
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Gynecologic cancers were 2.76 times more likely in women with endometriosis.
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The combined presence of endometriosis and fibroids increased reproductive tract cancer risk by 20%, with:
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34% increase for endometriosis alone.
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28% increase for fibroids alone.
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Cardiovascular Risk Differences
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Cardiovascular disease risk was:
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93% higher in women with endometriosis alone.
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61% higher in women with both endometriosis and fibroids.
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No significant increase with fibroids alone.
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Impact of Fibroids on Mortality
While uterine fibroids alone did not raise the overall risk of dying early, they more than doubled the risk of dying from gynecologic cancers (2.32 times higher).
When both conditions were present, the risks of dying from CVD and respiratory disease increased further.
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Endometriosis was linked to a 2.2-fold increase in respiratory death.
How This Study Differs From Past Research
Earlier research often overlooked important variables like hormone use, fertility history, or healthcare access. These oversights may have led to conflicting results. This new study took these factors into account, offering more precise insights into mortality risks.
Despite previous inconsistencies, several earlier studies did point to similar connections between these reproductive conditions and cancer risk.
Conclusions
Women with endometriosis and/or uterine fibroids may face a significantly higher risk of premature death. This increased risk persists even after their reproductive years. Cancer, particularly of the reproductive system, was the leading cause of death in this group.
Endometriosis also appeared to raise the risk of death from other diseases, including those affecting the lungs and nervous system. The interaction between endometriosis and fibroids creates a complex pattern of health risks that deserves more research.
Call for Further Research
Experts suggest more studies are needed to understand the biological mechanisms behind these risks. Better knowledge could lead to improved strategies for prevention, treatment, and long-term care for women with these common but serious conditions.
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