Risk Factors for Endometriosis in a German Case–Control Study

Abstract

Objective: The etiology of endometriosis is still a research field in which few consistent data are available. Large case–control studies or even cohort studies are rare, and most of the published data are conflicting. The aim of the present study was therefore to examine common epidemiological and endometriosis-specific risk factors in a German case–control study. Design: From 2001 to 2010, a pool of 595 laparoscopically confirmed cases and 475 controls were recruited in a hospital-based setting. After matching for age, 298 cases and 300 controls remained in the pool. Age at menarche, menstrual cycle length, duration of menstrual bleeding, number of pregnancies, live births, miscarriages, use of contraceptive pills, body mass index (BMI), and smoking status were analyzed with logistic regression models predicting endometriosis case–control status. Results: Menstrual cycle length, duration of menstrual bleeding, number of pregnancies, number of miscarriages, and smoking status, as relevant predictors for endometriosis case–control status, were identified as risk factors for endometriosis. Other factors such as age at menarche, number of live births, ever having used contraceptive pills, and BMI were not predictive. Conclusions: This hospital-based case–control study reproduced most of the familiar risk factors. Comparison of this study with others reveals a wide variety of effect sizes and directions of association with risk factors and may increase the information available about the characteristics of the patient population being treated in the relevant hospital setting.

Zusammenfassung

Einleitung: Die Ätiologie der Endometriose bleibt ein Forschungsgebiet mit spärlichen Erkenntnissen. Große Fall-Kontroll-Studien oder Kohortenstudien sind selten, und die publizierten Daten widersprechen sich auf den ersten Blick zum größten Teil. Ziel unserer Studie war es deswegen, in einer deutschen Fall-Kontroll-Studie Risikofaktoren zu identifizieren und zu beschreiben. Methoden: Von 2001 bis 2010 wurde ein Pool von 595 laparoskopisch diagnostizierten Endometriosepatientinnen und 475 in einem krankenhausbasierten Design rekrutiert. Von diesem Pool wurden 298 Fälle und 300 Kontrollen altersgematched. Ergebnisse: Alter bei der Menarche, Zyklusdauer, Dauer der Periodenblutung, Anzahl der Schwangerschaften und Lebendgeburten, Fehlgeburten, Pilleneinnahme, Body-Mass-Index (BMI) und Raucherstatus wurden in logistischen Regressionsmodellen auf ihre Prädiktion für den Endometriose-Fall-Kontroll-Status untersucht. Dauer der Periodenblutung, Dauer des Zyklus, Anzahl der Schwangerschaften, Anzahl der Fehlgeburten und Raucherstatus waren relevante und signifikante Risikofaktoren für die Endometriose. Die anderen Faktoren wie Alter bei Menarche, Anzahl der Lebendgeburten, Pillennutzung und BMI waren im multivariaten Modell nicht prädiktiv in Bezug auf den Fall-Kontroll-Status. In dieser krankenhausbasierten Fall-Kontroll-Studie konnten die meisten, bekannten Risikofaktoren für eine Endometrioseerkrankung reproduziert werden. Schlussfolgerung: Vergleicht man die Studie mit anderen, so fällt auf, dass die Variabilität der Effektstärke und der Richtung der Prädiktion für die Risikofaktoren in den meisten Studien unterschiedlich ist. Die Analyse der Risikofaktoren im eigenen Kollektiv könnte helfen, die Population der Endometriosepatientinnen besser zu verstehen, die im entsprechenden Krankenhaus behandelt werden.

Key words

endometriosis - risk factor - case-control study - epidemiology - genetics

Schlüsselwörter

Endometriose - Risiko - Fall-Kontroll-Studie - Epidemiologie - Genetik

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