A wide range of adverse childhood experiences could each increase the risk of endometriosis in later life, a study of over a million Swedish women suggests.
The research, in the journal Human Reproduction, shows how childhood difficulties can have profound consequences on future gynecological health and may help in identifying and managing at-risk women.
Researcher Marika Rostvall, a physician and doctoral student at the department of global public health at the Karolinska Institute, said the findings highlighted the importance of looking at the whole person, not just the symptoms.
“I think it is important that physicians listen carefully to patients’ stories and take their pain seriously,” she explained to Inside Precision Medicine.
“I also think it is very important that endometriosis care is team-based and involves multiple health care professions when necessary.”
Endometriosis is a gynecological disorder affecting one in 10 women of reproductive age, in which endometrial-like tissue grows outside the uterus. It can lead to agonizing menstrual periods, infertility, and chronic pain.
Noting that adverse childhood experiences such as parental separation, residential instability and violence can increase negative health outcomes such as heart disease, cancer, mental health disorders and diabetes, the researchers investigated a potential link with endometriosis.
The study included 1,316,946 women from several national registers, who were born in Sweden over a 27-year period. Of these, 24,311 had endometriosis, as registered by a health professional.
Childhood adverse experiences were identified through a variety of registers and defined as indicators of traumatic events or prolonged distressing conditions within a child’s family or social environment, associated with long-term adverse social or health outcomes.
They included: having a parent with substance abuse, intellectual disability or psychiatric disorder; familial death; having a teenage parent; child welfare intervention; parental separation; residential instability; receiving public assistance; exposure to interpersonal violence before the age of 15 years; and parental exposure to violence.
All the examined adversities, except familial death, were associated with a later endometriosis diagnosis, with the increase in risk generally varying from 20% to 35%. Exposure to violence had the strongest effect, more than doubling the risk of endometriosis (Hazard Ratio [HR]=2.38), with the weakest link shown for having a teenage parent (HR=1.20).
Experiencing any childhood adversity was associated with an increased risk of endometriosis (HR=1.20) and there was a cumulative effect, reaching around 60% increased risk for women who had suffered five or more (HR=1.61). Most of these experiences remained significantly associated with an increased risk of endometriosis after adjusting for other factors.
The team suggests that immune system alterations, such as systemic inflammation, or persistent sensitization of the central stress response systems may account for their findings.
They may also be linked with the increased pain felt by women who have had these experiences, which makes them more likely to seek medical care and receive a diagnosis.
“Our findings are in line with the increased focus on the importance of a multidisciplinary approach to endometriosis treatment, that may need to include psychological interventions,” the researchers concluded.
“Additionally, clinicians might need to be aware of childhood adversity as a potential risk factor for endometriosis development, and make sure to offer a thorough gynecological evaluation in individuals who have experienced childhood adversities and present with pelvic pain or dysmenorrhea.”
