University of Oulu

Rossi, H.-R., Uimari, O., Terho, A., Pesonen, P., Koivurova, S., & Piltonen, T. (2023). Increased overall morbidity in women with endometriosis: A population-based follow-up study until age 50. Fertility and Sterility, 119(1), 89–98.

Increased overall morbidity in women with endometriosis : a population-based follow-up study until age 50

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Author: Rossi, Henna-Riikka1,2; Uimari, Outi1,2; Terho, Anna1,2;
Organizations: 1Department of Obstetrics and Gynecology, Oulu University Hospital, Finland
2Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, University of Oulu, Oulu, Finland
3Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Elsevier, 2023
Publish Date: 2023-04-28


Objective: To investigate whether there is an association between endometriosis and nongynecological diseases in the general female population by age 50?

Design: A prospective cohort study.

Setting: Study participants with and without endometriosis were identified from a general population-based birth cohort. The analyzed data, linking to the national hospital discharge registers, spanned up to the age of 50 years.

Patient(s): Endometriosis case identification was based on national register data and self-reported diagnoses, producing a study population of 349 women with endometriosis and 3,499 women without endometriosis.

Main outcome measure(s): International Classification of Diseases diagnosis codes from 1968 to 2016 were accumulated from the Finnish national Care Register for Health Care, whereas self-reported symptoms and continuous medication usage data were collected from the questionnaires distributed at age 46. The associations between endometriosis and comorbidities were assessed using logistic regression models that included several covariates. The odds ratios and 95% confidence intervals (CIs) were modeled. Endometriosis subtype and temporal analyses were also performed.

Result(s): Women with endometriosis were on average twice as likely to have hospital-based nongynecological diagnoses as women without endometriosis (adjusted odds ratio [aOR] 2.32; 95% CI, 1.07–5.02). In more detail, endometriosis was associated with allergies, infectious diseases, pain-causing diseases, and respiratory diseases. Moreover, the affected women presented with nonspecific symptoms and signs (aOR 3.56; 95% CI, 2.73–4.64), especially abdominal and pelvic pain (aOR 4.33; 95% CI, 3.13–4.76) more often compared with nonendometriosis controls. The temporal analysis revealed that diagnoses accumulated at a significantly younger age among women with endometriosis than in nonendometriosis counterparts.

Conclusion(s): Women with endometriosis have a high risk for several chronic diseases compared with women without endometriosis, underlying the need for awareness and targeted resources for these women in the health care system. Moreover, endometriosis should be considered in the presence of nonspecific symptoms and abdominal pain, as they may conceal the disease and cause considerable delay in diagnosis and treatment.

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Series: Fertility and sterility
ISSN: 0015-0282
ISSN-E: 1556-5653
ISSN-L: 0015-0282
Volume: 119
Issue: 1
Pages: 89 - 98
DOI: 10.1016/j.fertnstert.2022.09.361
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: Supported by the Academy of Finland (315921, 321763), Sigrid Juselius Foundation, The Finnish Medical Association and Ahokkaan Säätiö. NFBC1966 received financial support from University of Oulu grant (65354 and 24000692), Oulu University Hospital grant (2/97, 8/97 and 24301140), Ministry of Health and Social Affairs grant (23/251/97, 160/97, 190/97), National Institute for Health and Welfare, Helsinki grant (54121), Regional Institute of Occupational Health, Oulu, Finland grant (50621, 54231), and European Regional Development Fund grant (539/2010 A31592).
Academy of Finland Grant Number: 315921
Detailed Information: 315921 (Academy of Finland Funding decision)
321763 (Academy of Finland Funding decision)
Copyright information: Copyright © 2022 The Authors. Published by Elsevier Inc. on behalf of the American Society for Reproductive Medicine. This is an open access article under the CC BY license (