Is endometriosis associated with infection-related diseases? Insights from a multicenter matched case-control study

Abstract

Endometriosis is an inflammatory disorder characterized by ectopic endometrial-like tissue and affects approximately 5–10% of reproductive-age women. Common symptoms include pelvic pain, infertility and fatigue. Until today the aetiology and the pathogenesis are not fully understood. Chronic inflammation and a dysregulation of the immune system are gaining more attention on their role in the development of and therapeutic approach against endometriosis, possibly pointing towards immunology-related comorbidities in affected women. The objective of this study was to determine whether there is an association between endometriosis and endometriosis symptoms, and selected infection-related symptoms as well as diseases with suspected immune pathogenesis. This multicenter, retrospective observational study included 568 women with histologically confirmed endometriosis matched by age (± 3 years) to 568 controls without endometriosis. Endometriosis diagnoses were surgically and histologically confirmed. After adjustment for potential confounders, endometriosis was significantly associated with the reported frequency of flu-like infections (OR 5.678 for the category “frequent/very frequent” versus “never”, p  = 0.001). In a subgroup analysis of women with endometriosis, infection susceptibility did not correlate with rASRM stage but was associated with a greater number of endometriosis surgeries ( p  = 0.0038) and a slightly increased pain intensity ( p  = 0.03). This study identified an association between endometriosis and increased frequency of participant-reported, possibly infection-related symptoms, particularly flu-like symptoms. These findings are consistent with the concept of endometriosis as a systemic inflammatory disease and underline the importance of considering infectious and immune comorbidities in the clinical management of endometriosis. The study was registered at ClinicalTrials.gov (NCT 02511626, first submitted 2015-07-20).