ASRM2012: Child abuse associated with slight increase in risk for endometriosis

San Diego, 22 October 2012

Evidence from epidemiologic studies suggest that early trauma is associated with disease of the reproductive tract [1].  Research from Harvard University has shown that women who report child sexual and physical abuse have a 34% greater risk of being diagnosed with endometriosis in later life [2].

Data was collected from the Nurses Health Study II, an ongoing prospective cohort study of US nurses aged 25-42 at enrolment in 1989.  A retrospective questionnaire on childhood violence exposure was completed in 2001 (n=60,410).

Associate Professor Stacey Missmer at the 68th Annual Meeting of the ASRM

Senior researcher, associate professor Stacey Missmer PhD, explained today that severity and the longer duration of child/adolescent sexual and physical abuse was associated with a greater risk of developing endometriosis.

She stressed that the association is not psychological, but very much physical as the Nurses’ Health Study II also showed an increased risk of developing fibroids [3], cardiovascular disease [4], hypertension [5] and diabetes II [6].  This has also been confirmed in data from the Centre for Disease Control, where those with adverse childhood experiences showed an increased risk of developing ischemic heart disease, lung disease, cancer, bone fractures, and liver disease [7].

Stress from a history of physical or sexual abuse affects hormonal and central nervous system inflammatory processes, which may result in chronic disease, coined as “The long shadow” by study co-author, Janet Rich-Edwards.  Extreme events affect the whole body, and reproductive health is just one component of that effect.

As the above picture illustrates, childhood and adolescence is a critical window in terms of disease development and often exposures that occurred then will have a longer term effect on health.

This finding provides an interesting new risk factor that may add to the evidence regarding the aeteology of endometriosis.  But, this is a single study, so it remains to be examined further in the context of proven risk factors,

said Dr Missmer.

  1. Paras ML, et al. Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. JAMA 2009;302:550-561.
  2. Wieser F, et al. Abuse in childhood and risk of endometriosis. Fertil Steril 2012;98(3):S218.
  3. Boynton-Jarret R, et al. Abuse in childhood and risk of uterine leiomyoma: the role of emotional support in biologic resilience. Epidemiology 2011;22(1):6-14.
  4. Rich-Edwards JW, et al. Physical and sexual abuse in childhood as predictors of early-onset cardiovascular events in women. Circulation 2012;126(8):920-7.
  5. Riley EH, et al. Hypertension in adult survivors of child abuse: observations from the Nurses’ Health Study II. J Epidemiol Community Health 2010;64(5):413-8.
  6. Rich-Edwards JW, et al. Abuse in childhood and adolescence as a predictor of type 2 diabetes in adult women. Am J Prev Med 2010;39:529-36.
  7. Felitti VJ. Adverse childhood experiences and adult health. Acad Pediatr 2009;9(3):131-2.
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