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Hum. Reprod. Advance Access published online on October 23, 2007
Human Reproduction, doi:10.1093/humrep/dem338
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Intrauterine exposures and risk of endometriosis

Germaine M. Buck Louis1,3, Mary L. Hediger1 and Josefa B. Peña2

1 Department of Health and Human Services, Epidemiology Branch, National Institute of Child Health & Human Development, 6100 Executive Blvd., Room 7B03, Rockville, Maryland 20852, USA 2 Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A & M University Health Science Center, College Station, Texas 77843, USA

3Correspondence address. Tel: +1-301-496-6155; Fax: +1-301-402-2084; E-mail: louisg{at}mail.nih.gov

BACKGROUND: Intrauterine environmental exposures have been adversely associated with male reproductive health in contrast to limited investigation of such exposures and female reproductive health.

METHODS: To address this research gap, a cohort comprising 84 women aged 18–40 years undergoing laparoscopy was recruited prior to surgery and followed through the post-operative period for endometriosis diagnosis. Women were interviewed about environmental exposures and those of their mothers while pregnant with them (use of alcohol, caffeinated beverages and cigarettes). Endometriosis was diagnosed in 32 women from the laparoscopy cohort; 52 women had no endometriosis visualized. Using unconditional logistic regression, odds ratios (OR) and 95% confidence intervals (CIs) were estimated for the intrauterine exposures adjusting for potential confounders.

RESULTS: No significant associations were seen between intrauterine exposure to alcohol or caffeine and a diagnosis of endometriosis. Adjusting for age, significant reductions in odds of an endometriosis diagnosis were observed for intrauterine cigarette exposure both in the absence (OR 0.22, 95% CI 0.06–0.82) or presence (OR 0.05, 95% CI 0.01–0.42) of women’s current smoking.

CONCLUSIONS: While speculative, in utero cigarette exposure may be associated with a lower risk of surgically diagnosed adult-onset endometriosis, possibly as a result of alterations in hormonal milieu or pathologic angiogensis.

Key words: angiogenesis/cigarette smoking/endometriosis/gynecologic health/intrauterine

Submitted on August 21, 2007; resubmitted on September 19, 2007; accepted on September 27, 2007.


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