Women living with endometriosis face a significantly higher chance of developing Type 2 diabetes, a link that appears strongest in premenopausal women who do not have obesity. The research, published in Diabetologia last August, suggests that the chronic nature of this gynecological disorder extends its impact well beyond the reproductive system.
A Hidden Link in Health Records
The study, led by Maggie Fuzak Nunziato of George Mason University, analyzed electronic health records from the Utah Population Database. The team examined data for nearly 3 million women who lived in Utah between 1996 and 2021.
Within that vast dataset, researchers identified almost 100,000 women who had received a formal diagnosis of endometriosis.
Endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus. It can attach to the ovaries, fallopian tubes, and the outer surface of the uterus. Pain is the most common symptom, though bleeding, infertility, and digestive issues also occur.
According to the U.S. Health and Human Services, the condition affects more than 11% of American women between the ages of 15 and 44. It is particularly prevalent among women in their 30s and 40s.
Nunziato noted that previous studies often treated endometriosis as an isolated issue. “Previous studies largely evaluated endometriosis as a single condition and generally reported little or no overall association with Type 2 diabetes,” she said in a news release. Her team’s work adds to a growing understanding that the condition may affect more than just reproductive health.
Risk Varies by Condition Type
The analysis revealed that women with endometriosis had an overall 46% higher risk of developing Type 2 diabetes. However, this risk was not uniform across all patients. It was highest among women with extra-pelvic endometriosis, a form where the disease is found outside the pelvis.
Surprisingly, the association was strongest among women with a body mass index (BMI) lower than 30 kg/m2. This group includes women who are underweight, at a healthy weight, or overweight but not obese. These patients have generally not been considered at risk for diabetes based on weight alone.
Researchers said they believe the chronic inflammation associated with endometriosis may play a role in metabolic health.
Limitations and Future Directions
The researchers acknowledged several limitations in their study design. Patients were identified using ICD codes, which can sometimes lead to misclassification. Furthermore, women with endometriosis tend to see healthcare providers more frequently. This increased contact with the medical system raises the likelihood that diabetes is detected and recorded, potentially skewing the results.
The study did not measure factors such as diet, physical activity, or hormone treatment use, all of which can influence metabolic outcomes. Despite these gaps, the findings support the need for further investigation into the biological mechanisms linking reproductive and metabolic health. “These findings may have implications for future research on metabolic risk assessment among individuals with endometriosis,” the researchers wrote.
