Obesity is linked to an increase in endometriosis severity and a reduced frequency of minimal stage disease, according to new research from Australia.
The study was published in the Journal of Endometriosis and Pelvic Pain Disorders.
Endometriosis is a painful gynecological disease that affects approximately 6-10% of reproductive-age women. Due to its high negative impact on quality of life, a better understand its underlying mechanisms became a priority for the development of effective therapies, and to find ways to categorize patients to improve treatment decisions.
Previous studies have revealed that endometriosis patients often have a lower body mass index (BMI) than healthy women, and are more frequently underweight. Bit it’s not clear if low body weight is a contributing factor for the disease or a consequence of it.
In the study titled “The association of body mass index with endometriosis and disease severity in women with pain.” a research team evaluate the association between obesity and endometriosis severity.
The team analyzed the clinical records of 509 pre-menopausal women who underwent laparoscopic surgery for the investigation of gynecological pain. A final diagnosis of endometriosis was achieved in 357 of the 509 women.
In line with previous studies, researchers found that women with endometriosis had a lower mean BMI than women without the disease.
Still, the endometriosis group had a mean BMI that was borderline between normal and pre-obesity, while the women without endometriosis were, on average, pre-obese.
This pattern was similar to that reported in the Australian National Health Survey for BMI distribution among Australian endometriosis patients.
Following the same trend, they found an inverse correlation between BMI and endometriosis, with a higher incidence of the disease in underweight women and significantly reduced endometriosis frequency in overweight women.
Interestingly, women with obesity who had endometriosis were found to be less likely to have minimal (stage 1) disease. Indeed, 40% of the patients with obesity had moderate-severe endometriosis (stage 3-4) compared to 24-26% of the normal and pre-obesity patients.
In general, obese patients had significantly higher disease severity scores compared to women who were pre-obese as well as those with normal BMIs.
Supported by these results, the researchers suggest that there’s too much “scrutiny over a low BMI in association with endometriosis,” and research emphasis should shift to “understanding the impact of obesity on endometriosis, and in particular, the difference observed in disease severity.”
“It remains unclear what role body mass index has in the cause or effect of endometriosis,” researchers wrote. “We propose that BMI may be a useful candidate for assisting in improved endometriosis disease sub-classification,” they added, which could have implications for management and treatment decisions.
“This study has important clinical applications, with surgeons now aware of the need to provide more time for surgery in obese women as they are more likely to have extensive endometriosis requiring removal,” Sarah Holdsworth-Carson, PhD, a researcher at the University of Melbourne and Gynaecology Research Centre, and the study’s lead author, said in an interview with The Guardian.