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Reproductive history and endometriosis among premenopausal women.

Abstract

OBJECTIVE

To clarify the temporal complexities of the relation between reproductive factors and endometriosis.

METHODS

We analyzed 10 years of prospective data from the Nurses' Health Study II cohort. Information was obtained through questionnaires sent every 2 years to 116,678 women aged 25-42 years when enrolled in 1989. Cox proportional hazards models were used to adjust for age, calendar time, and confounding variables.

RESULTS

During 726,205 woman-years of follow-up, 1,721 cases of laparoscopically confirmed endometriosis were reported among women with no past infertility. Greater incidence was observed among women with an earlier age at menarche (rate ratio of 1.3 comparing menarche at age < 10 to age 12 years; 95% confidence interval [CI] 1.0-1.8; P value, test for trend < .001) and shorter cycle length during late adolescence (rate ratio of 1.3 comparing < 26 days to 26-31 days; 95% CI 1.1-1.5). Time to cycle regularity was not associated with risk. Among parous women, a linear decrease in risk was observed with number of liveborn children (rate ratio of 0.5 comparing > 3 with 2 children; 95% CI 0.4-0.7; P value, test for trend < .001) and lifetime duration of lactation if time since last birth was less than 5 years (rate ratio of 0.2 comparing > 23 months with never; 95% CI 0.1-0.4; P value, test for trend < .001).

CONCLUSION

Hormonal and anatomical changes associated with menstruation and pregnancy may affect the rate of laparoscopically confirmed endometriosis. Within this cohort, risk was greatest among nulliparous women with earlier age at menarche and shorter menstrual cycles. Among parous women, parity and lifetime duration of lactation were associated with decreased risk.

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  • Authors+Show Affiliations

    ,

    Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115-5804, USA. stacey.missmer@channing.harvard.edu

    , , , , ,

    Source

    Obstetrics and gynecology 104:5 Pt 1 2004 Nov pg 965-74

    MeSH

    Adult
    Endometriosis
    Female
    Humans
    Lactation
    Menarche
    Menstrual Cycle
    Parity
    Proportional Hazards Models
    Prospective Studies
    Risk Factors

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    15516386

    Citation

    Missmer, Stacey A., et al. "Reproductive History and Endometriosis Among Premenopausal Women." Obstetrics and Gynecology, vol. 104, no. 5 Pt 1, 2004, pp. 965-74.
    Missmer SA, Hankinson SE, Spiegelman D, et al. Reproductive history and endometriosis among premenopausal women. Obstet Gynecol. 2004;104(5 Pt 1):965-74.
    Missmer, S. A., Hankinson, S. E., Spiegelman, D., Barbieri, R. L., Malspeis, S., Willett, W. C., & Hunter, D. J. (2004). Reproductive history and endometriosis among premenopausal women. Obstetrics and Gynecology, 104(5 Pt 1), pp. 965-74.
    Missmer SA, et al. Reproductive History and Endometriosis Among Premenopausal Women. Obstet Gynecol. 2004;104(5 Pt 1):965-74. PubMed PMID: 15516386.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Reproductive history and endometriosis among premenopausal women. AU - Missmer,Stacey A, AU - Hankinson,Susan E, AU - Spiegelman,Donna, AU - Barbieri,Robert L, AU - Malspeis,Susan, AU - Willett,Walter C, AU - Hunter,David J, PY - 2004/11/2/pubmed PY - 2004/12/31/medline PY - 2004/11/2/entrez SP - 965 EP - 74 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 104 IS - 5 Pt 1 N2 - OBJECTIVE: To clarify the temporal complexities of the relation between reproductive factors and endometriosis. METHODS: We analyzed 10 years of prospective data from the Nurses' Health Study II cohort. Information was obtained through questionnaires sent every 2 years to 116,678 women aged 25-42 years when enrolled in 1989. Cox proportional hazards models were used to adjust for age, calendar time, and confounding variables. RESULTS: During 726,205 woman-years of follow-up, 1,721 cases of laparoscopically confirmed endometriosis were reported among women with no past infertility. Greater incidence was observed among women with an earlier age at menarche (rate ratio of 1.3 comparing menarche at age < 10 to age 12 years; 95% confidence interval [CI] 1.0-1.8; P value, test for trend < .001) and shorter cycle length during late adolescence (rate ratio of 1.3 comparing < 26 days to 26-31 days; 95% CI 1.1-1.5). Time to cycle regularity was not associated with risk. Among parous women, a linear decrease in risk was observed with number of liveborn children (rate ratio of 0.5 comparing > 3 with 2 children; 95% CI 0.4-0.7; P value, test for trend < .001) and lifetime duration of lactation if time since last birth was less than 5 years (rate ratio of 0.2 comparing > 23 months with never; 95% CI 0.1-0.4; P value, test for trend < .001). CONCLUSION: Hormonal and anatomical changes associated with menstruation and pregnancy may affect the rate of laparoscopically confirmed endometriosis. Within this cohort, risk was greatest among nulliparous women with earlier age at menarche and shorter menstrual cycles. Among parous women, parity and lifetime duration of lactation were associated with decreased risk. SN - 0029-7844 UR - https://www.unboundmedicine.com/medline/citation/15516386/full_citation L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=15516386.ui DB - PRIME DP - Unbound Medicine ER -