Endometriosis affects nearly 10 per cent (190 million)of reproductive age women worldwide, according to the World Health Organisation (WHO). A new study suggests that the impact of endometriosis may go beyond painful periods, pelvic discomfort and fertility problems. The study has found that women with endometriosis had a 46 per cent higher relative risk of developing type 2 diabetes compared with women without the condition. This link was observed even after researchers accounted for factors including age and body mass index (BMI).

Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus, commonly around the ovaries, fallopian tubes and other areas of the pelvis. The condition usually causes inflammation, pain, heavy or irregular bleeding and, in some women, difficulty becoming pregnant.

What Did The Study Find?

The study, published in Diabetologia, analysed health records of 29,39,364 women from the Utah Population Database between 1996 and 2021. Nearly 1,00,000 women had been diagnosed with endometriosis. Participants were followed for an average of 10.8 years. 

Researchers found that women with endometriosis had a 46 per cent higher risk of developing type 2 diabetes than women who did not have the condition. The association was dependent on the type and location of endometriosis. This relationship was also stronger among women who were premenopausal, with a 55 per cent higher relative risk compared with women without endometriosis.

Another finding was seen among women with a BMI below 30. In this group, the relative association was higher than among women with obesity. This does not mean that women without obesity have a higher absolute risk of diabetes than women with obesity. Instead, it suggests that endometriosis could represent an additional risk factor that may otherwise be overlooked.

Link Between Endometriosis And Diabetes

The exact biological explanation is not yet known. However, inflammation is one possible connection. Endometriosis is an inflammatory condition. Persistent inflammation can affect several processes in the body, including how cells respond to insulin. Insulin is the hormone that helps move glucose from the blood into cells, where it can be used for energy. When the body's cells become less responsive to insulin, one might develop insulin resistance. The pancreas may initially produce more insulin to compensate. However, over time, blood glucose levels can increase, which eventually increases the risk of type 2 diabetes.

The researchers suggest that inflammation linked to endometriosis may lead to metabolic changes, but the study did not directly establish this.

Why Is Finding Important For Women Without Obesity?

Obesity is known to be a risk factor for type 2 diabetes, hence BMI is often considered when assessing someone's metabolic risk. The new study says that this approach may not be able to capture every risk factor.

Women with endometriosis and a normal or moderately high BMI may not be considered at a high risk of type 2 diabetes. However, the study found a stronger association between endometriosis and diabetes in women with BMI below 30. This does not mean that everyone with endometriosis needs diabetes testing immediately. Instead, the study suggests that healthcare professionals may need to consider the person's complete health history.

Does Menopause And Gestational Diabetes Affect The Risk?

The link between endometriosis and type 2 diabetes was stronger among premenopausal women than postmenopausal women. Researchers found a 55 per cent higher relative risk among premenopausal women, compared with a smaller association after menopause. Hormonal changes may be the reason for this difference

The researchers also examined whether a history of gestational diabetes explained the link between the two. Gestational diabetes is diabetes that develops during pregnancy and can increase the future risk of type 2 diabetes. The association between endometriosis and type 2 diabetes was there even when researchers considered previous gestational diabetes.

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