N, SD Cleary, ML Ballweg, LK Niewman and P Stratton. 2002. High
rates of autoimmune and endocrine disorders, fibromyalgia, chronic
fatigue syndrome and atopic diseases among women with endometriosis:
a survey analysis. Human
study reveals that women with endometriosis are much more
likely to also suffer from a cluster of other autoimmune and endocrine
disorders than are women in the general US public. Allergies,
asthma, chronic fatigue syndrom, lupus, hypothyroidism and other
diseases were far more common in endometriosis sufferers. The study
also document significantly greater infertility among women with
research is important for two reasons. First, it puts endometriosis
patients, their families and physicians on the alert for other health
problems that accompany endometriosis. Second, it reinforces the
sense that endometriosis is a disease of the immune and endocrine
also raises the possibility that this collection of disorders may
share in part or in whole some common mechanisms or causes. Because
of strong indications implicating
dioxins in the etiology of endometriosis via disruptive impacts
on the immune and endocrine systems, the pattern of co-occurrence
of disease revealed by this paper suggests dioxins' role in these
other diseases should be studied, also.
did they do? Sinaii et al. mailed a questionnaire
to approximately 10,000 members of the Endometriosis
Association to obtain data on other health problems they had
or were experiencing. The analysis was limited to responding endometriosis
patients whose condition had been confirmed surgically. The survey
obtained basic demographic information as well as health data reflecting
disease and reproductive history. Disease status was dependent upon
diagnosis by a physician, except for asthma, eczema and allergies.
Family histories of endometriosis were also obtained.
did they find? Among the 4000 questionnaires analyzed,
3680 were from women confirmed surgically to have endometriosis.
Compared to the general public, respondents were more likely to
be white, have a higher income, be college-educated and be of reproductive
age. This reflects the fact that members of the Endometriosis Association
must pay annual dues and have the time, inclination and education
to seek out the Association. Women with higher income may also be
more able to afford a surgical diagnosis for endometriosis.
data revealed that on average, it took 10 years from the first onset
of pelvic pain to an actual diagnosis of endometriosis.
rates of questionnaire respondents averaged markedly higher than
the US population overall. By separating the respondents into different
age groups (figure below), it can be seen that this difference becomes
apparent with age.
differences were observed among women from ages 15 to 24.
Infertility was lower in the general US population from ages
25 to 44 ( p < 0.001). Women with both endometriosis and
either endocrine disease or fibromyalgia and chronic fatigue
syndrome showed less infertility than endometrioisis alone.
evident in the table below, Sinaii et al. found striking
patterns of co-occurrence of a variety of disorders. Women with
endometriosis are far more likely to also have several autoimmune
inflammatory diseases, endocrine diseases and chronic pain and fatigue
states: for example, almost 21 times more likely to have
lupus, 7 times more likely to have hypothyroidism,
and 180 times more likely to have chronic fatigue syndrome.
system abnormalities were also more prevalent among women
with endometriosis, and even more so if they had additional
does it mean? Any self-reporting survey has limitations
that make it important to be cautious in reaching conclusions. Sinaii
et al. carried out a series of sensitivity analyses to
ask, in essence, "how wrong would the survey results have to
be to change the qualitative nature of the results." The answer:
dramatically so, more than is likely to result from errors that
may or may not have been introduced by the study procedure.
essence, the clear qualitative pattern is that endometriosis travels
together in a pattern of diseases involving the endocrine and immune
systems. Women with endometriosis are clearly at risk to these other
disorders. Women, families and physicians should be alert to the
clues that the presence of endometriosis gives for other diseases,
and vice-versa. Informed vigilance may shorten the decade or longer
that often drags on between onset of endometriosis and diagnosis.
research also raises the possibility of shared causal factors among
these different diseases. Research pursuing this hypothesis is clearly
warranted. Because of strong links between dioxin and endometriosis,
the enormous odds ratio reported here for endometriosis and chronic
fatigue syndrome raises the plausibility of suggested links between
chronic fatigue and dioxin.