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Physical, sexual abuse in early life increases risk of endometriosis

Physical, sexual abuse in early life increases risk of endometriosis

An analysis of nearly 3,400 endometriosis cases with over 24 years of follow-up found that, women who experienced physical or sexual abuse during early life were at an increased risk of developing endometriosis. Listen to a commentary by Charles E. Miller, MD, a specialist in gynecologic surgery in Chicago.

BY JEFF CRAVEN

MDedge News

FROM HUMAN REPRODUCTION

Women who experienced physical or sexual abuse during early life are at an increased risk of developing endometriosis, according to results of a large study with long follow-up published in Human Reproduction.

Click here to listen to Dr. Charles E. Miller’s audio commentary:

Women who experienced physical or sexual abuse during early life are at an increased risk of developing endometriosis, according to results of a large study with long follow-up published in Human Reproduction.

This study found women who reported severe, chronic abuse of multiple types had a 79% increased risk of endometriosis confirmed by laparoscopy, according to an analysis of nearly 3,400 endometriosis cases with over 24 years of follow-up.

Charles E. Miller, MD

“Our findings of a stronger association between early life abuse and pain-associated endometriosis suggest that the mechanism(s) underlying the association between abuse and endometriosis could share similarities with [chronic pelvic pain] and other pain syndromes,” Holly R. Harris, MPH, ScD, of the Fred Hutchinson Cancer Research Center in Seattle and her colleagues wrote.


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Dr. Harris and her colleagues identified 3,394 cases of laparoscopically confirmed endometriosis from questionnaires completed by 60,595 women in the Nurses’ Health Study II (NHSII), an ongoing prospective investigation into chronic diseases suffered by women since 1989. In 2001, a questionnaire on violence victimization went to 91,248 women in the study, and of these women, 68,595 completed it. The investigators excluded women who had baseline reports of endometriosis, cancer, were postmenopausal or had no reported menopausal state and who had a hysterectomy.

Abuse was labeled as harsh and punitive parenting, physical abuse, and sexual abuse based on scoring from the Childhood Trauma Questionnaire short form (CTQ-SF), Conflict Tactics Scale (CTS), and questions modified from the Sexual Experiences Survey (SES), respectively. Cumulative abuse was divided into mild- or moderate-single type, mild-multiple or severe-single type, moderate-chronic or moderate-multiple type, severe-chronic or severe-multiple type, and severe-chronic and -multiple types.

The investigators found the greatest increased risk of endometriosis was associated with women who experienced combined physical and sexual abuse (hazard ratio, 1.31; 95% confidence interval, 1.19-1.45), with a lower increased risk of endometriosis among women who experienced physical abuse alone (HR, 1.10; 95% CI, 1.01-1.20) and sexual abuse alone (HR, 1.15; 95% CI, 1.03-1.30).

When considering the severity of sexual abuse, the highest risk of endometriosis was linked to a history of forced sexual activity at childhood and during adolescence (HR, 1.49; 95% CI, 1.24-1.79).

Moderate (HR, 1.20; 95% CI, 1.11-1.31) and severe physical abuse (HR, 1.20; 95% CI, 1.06-1.37) also were associated with an increased risk of developing endometriosis.

Regarding cumulative abuse, risk of developing endometriosis was 12% greater among women who experienced a single mild or moderate abuse event (95% CI, 1.03-1.21), 17% higher among women who experienced a mild-multiple or severe-single abuse event (95% CI, 1.05-1.30), and 36% higher in women who experienced a moderate-chronic or moderate-multiple abuse event (95% CI, 1.19-1.55), all compared with women who never reported abuse events. Likewise, risk of developing endometriosis was 34% higher among women who experienced a severe-chronic or severe-multiple abuse event (95% CI, 1.10-1.62) and 79% higher among women who experienced an event defined as severe-chronic or severe-multiple abuse (95% CI, 1.44-2.22), compared with women who were never abused.

Dr. Harris and her colleagues noted women with infertility in the study who reported any form of abuse did not have an increased risk of endometriosis in any of the fully adjusted models, but “the magnitude of the effects was increased considerably” for women who never reported infertility but experienced forced sexual abuse during childhood and as an adolescent (HR, 1.72; 95% CI, 1.41-2.11). Factors such as a patient population of middle-aged white nurses, recall bias, and selection bias were potential limitations in the study, they said.

“Much of the literature relating childhood abuse to adult pain experiences describes an increased incidence of medically unexplained symptoms and focuses on health care-seeking behavior and ‘psychogenic’ symptoms. The findings of this study are therefore of particular importance as they highlight the association between a history of childhood/adolescence abuse and a pathology commonly associated with chronic pain in women,” Dr. Harris and her colleagues wrote. “Whilst psychosocial factors may still contribute, an increased focus on the potential underlying biologic mechanisms is necessary to fully understand these relationships.”

This study was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Atlanta Clinical and Translational Science Institute. Dr. Harris received support through grants from the National Institutes of Health and the National Cancer Institute. The other authors report no relevant conflicts of interest. The Nurses’ Health Study II is supported by a grant from the National Cancer Institute.

SOURCE: Harris HR et al. Hum Reprod. 2018 July 17. doi: 10.1093/humrep/dey248.