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Is there a connection between adverse childhood circumstances and the later development of endometriosis? Marika Rostvall, MD, doctoral student at the Department of Global Public Health, Karolinska Institutet in Stockholm, Sweden, and colleagues investigated the question in a nationwide cohort study.

Researchers found that several factors, including parental substance abuse, intellectual disability, psychiatric disorder, teen parenthood, child-welfare involvement, parental separation, residential instability, reliance on social assistance, and both personal and parental experiences of violence, were linked to an increased risk for endometriosis. The risk increased with the number of adverse childhood circumstances experienced.

While the underlying cause of endometriosis remains unclear, researchers have highlighted the importance of identifying potential risk factors. Previous epidemiologic studies have reported mixed findings, with some linking childhood abuse to a higher endometriosis risk and others finding no significant association.

Strongest Link

This study included all women born in Sweden between 1974 and 2001. Women who died before the age of 15, emigrated, or were diagnosed with endometriosis and women who were adopted were excluded.

Of the 1,316,946 women in the analysis sample, 24,311 were diagnosed with endometriosis based on ICD codes registered by a healthcare professional. The researchers used national registers to identify adverse childhood circumstances and calculated hazard ratios (HRs) using Cox regression analysis.

All childhood experiences, except death in the family, were associated with a higher endometriosis risk. Experiences of violence showed the strongest link (HR, 2.38), and teen parenthood showed the weakest link (HR, 1.20).

Having experienced any adversity was significantly associated with an increased risk for endometriosis diagnosis (HR = 1.20; 95% CI, 1.17-1.24), and the risk increased with an increasing number of adversities, with an up to 60% increase in risk among those who had five or more adversities (HR = 1.61).

“The results of our study suggest that early life adversity is associated with an increased risk of being diagnosed with endometriosis. This finding could help guide further etiological research. It also strengthens the already large amount of evidence showing that childhood adversity has profound consequences for future health and that there is a need for effective policies to protect children and support parents.

Additionally, clinicians might need to be aware of childhood adversity as a potential risk factor for endometriosis development and make sure to offer a thorough gynecological evaluation in individuals who have experienced childhood adversities and present with pelvic pain or dysmenorrhea,” the authors wrote.

This story was translated from Medscape’s Portuguese edition.