Obstet Gynecol Sci.  2022 May;65(3):227-233. 10.5468/ogs.21343.

What is the link between endometriosis and adiposity?

Affiliations
  • 1Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea

Abstract

Endometriosis is defined by the presence of extrauterine endometrial tissue and presents with symptoms of dysmenorrhea, chronic pelvic pain, and impaired fertility. This condition often follows a chronic progressive course with favorable recurrence, even after surgical or medical treatment. The etiology or exact pathophysiology of endometriosis remains to be clarified, although it is thought to be a complex and multifactorial disease. Prior epidemiological or population-based studies have reported several risk factors related to endometriosis, such as environmental, menstrual, habitual, and lifestyle factors. Moreover, anthropometry has been found to be significantly associated with the diagnosis of endometriosis, as a lower body mass index is associated with an elevated risk of endometriosis. Here, we review studies that have examined the association between body size and the risk of endometriosis and discuss the clinical and biological significance of the relationship between adiposity and endometriosis.

Keyword

Endometriosis; Adiposity; Anthropometry; Obesity; Adipokines

Reference

References

1. Giudice LC, Kao LC. Endometriosis. Lancet. 2004; 364:1789–99.
Article
2. Buck Louis GM, Hediger ML, Peterson CM, Croughan M, Sundaram R, Stanford J, et al. Incidence of endometriosis by study population and diagnostic method: the ENDO study. Fertil Steril. 2011; 96:360–5.
Article
3. Bulun SE. Endometriosis. N Engl J Med. 2009; 360:268–79.
Article
4. Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012; 39:535–49.
5. Rogers PA, D’Hooghe TM, Fazleabas A, Gargett CE, Giudice LC, Montgomery GW, et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci. 2009; 16:335–46.
Article
6. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012; 98:511–9.
Article
7. Sampson JA. Metastatic or embolic endometriosis, due to the menstrual dissemination of endometrial tissue into the venous circulation. Am J Pathol. 1927; 3:93–110.43.
8. Batt RE, Smith RA, Buck Louis GM, Martin DC, Chapron C, Koninckx PR, et al. Müllerianosis. Histol Histopathol. 2007; 22:1161–6.
9. Suginami H. A reappraisal of the coelomic metaplasia theory by reviewing endometriosis occurring in unusual sites and instances. Am J Obstet Gynecol. 1991; 165:214–8.
Article
10. Cramer DW, Wilson E, Stillman RJ, Berger MJ, Belisle S, Schiff I, et al. The relation of endometriosis to menstrual characteristics, smoking, and exercise. JAMA. 1986; 255:1904–8.
Article
11. Missmer SA, Cramer DW. The epidemiology of endometriosis. Obstet Gynecol Clin North Am. 2003; 30:1–19. vii
Article
12. Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol. 2004; 160:784–96.
Article
13. McLeod BS, Retzloff MG. Epidemiology of endometriosis: an assessment of risk factors. Clin Obstet Gynecol. 2010; 53:389–96.
14. Darrow SL, Vena JE, Batt RE, Zielezny MA, Michalek AM, Selman S. Menstrual cycle characteristics and the risk of endometriosis. Epidemiology. 1993; 4:135–42.
Article
15. Hemmings R, Rivard M, Olive DL, Poliquin-Fleury J, Gagné D, Hugo P, et al. Evaluation of risk factors associated with endometriosis. Fertil Steril. 2004; 81:1513–21.
Article
16. Signorello LB, Harlow BL, Cramer DW, Spiegelman D, Hill JA. Epidemiologic determinants of endometriosis: a hospital-based case-control study. Ann Epidemiol. 1997; 7:267–741.
Article
17. Ferrero S, Anserini P, Remorgida V, Ragni N. Body mass index in endometriosis. Eur J Obstet Gynecol Reprod Biol. 2005; 121:94–8.
Article
18. Shah DK, Correia KF, Vitonis AF, Missmer SA. Body size and endometriosis: results from 20 years of follow-up within the Nurses’ Health Study II prospective cohort. Hum Reprod. 2013; 28:1783–92.
Article
19. Parazzini F, Chiaffarino F, Surace M, Chatenoud L, Cipriani S, Chiantera V, et al. Selected food intake and risk of endometriosis. Hum Reprod. 2004; 19:1755–9.
Article
20. Moini A, Malekzadeh F, Amirchaghmaghi E, Kashfi F, Akhoond MR, Saei M, et al. Risk factors associated with endometriosis among infertile Iranian women. Arch Med Sci. 2013; 9:506–14.
Article
21. Shahbazi S, Shahrabi-Farahani M. Evaluation of the correlation between body mass index and endometriosis among Iranian fertile women. Gynecol Endocrinol. 2016; 32:157–60.
Article
22. Liu Y, Zhang W. Association between body mass index and endometriosis risk: a meta-analysis. Oncotarget. 2017; 8:46928–36.
Article
23. Nagle CM, Bell TA, Purdie DM, Treloar SA, Olsen CM, Grover S, et al. Relative weight at ages 10 and 16 years and risk of endometriosis: a case-control analysis. Hum Reprod. 2009; 24:1501–6.
Article
24. Hediger ML, Hartnett HJ, Louis GM. Association of endometriosis with body size and figure. Fertil Steril. 2005; 84:1366–74.
Article
25. Vitonis AF, Baer HJ, Hankinson SE, Laufer MR, Missmer SA. A prospective study of body size during childhood and early adulthood and the incidence of endometriosis. Hum Reprod. 2010; 25:1325–34.
Article
26. Caprio S, Bronson M, Sherwin RS, Rife F, Tamborlane WV. Co-existence of severe insulin resistance and hyperinsulinaemia in pre-adolescent obese children. Diabetologia. 1996; 39:1489–97.
Article
27. Baer HJ, Colditz GA, Willett WC, Dorgan JF. Adiposity and sex hormones in girls. Cancer Epidemiol Biomarkers Prev. 2007; 16:1880–8.
Article
28. Koutsilieris M, Mastrogamvrakis G, Lembessis P, Sourla A, Miligos S, Michalas S. Increased insulin-like growth factor 1 activity can rescue KLE endometrial-like cells from apoptosis. Mol Med. 2001; 7:20–6.
Article
29. Kim JG, Suh CS, Kim SH, Choi YM, Moon SY, Lee JY. Insulin-like growth factors (IGFs), IGF-binding proteins (IGFBPs), and IGFBP-3 protease activity in the peritoneal fluid of patients with and without endometriosis. Fertil Steril. 2000; 73:996–1000.
Article
30. Selak V, Farquhar C, Prentice A, Singla A. Danazol for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2001; (4):CD000068..
Article
31. Holdsworth-Carson SJ, Dior UP, Colgrave EM, Healey M, Montgomery GW, Rogers PAW, et al. The association of body mass index with endometriosis and disease severity in women with pain. J Endometriosis Pelvic Pain Disorders. 2018; 10:79–87.
Article
32. Pantelis A, Machairiotis N, Lapatsanis DP. The formidable yet unresolved interplay between endometriosis and obesity. ScientificWorldJournal. 2021; 2021:6653677.
Article
33. Ashrafi M, Sadatmahalleh SJ, Akhoond MR, Talebi M. Evaluation of risk factors associated with endometriosis in infertile women. Int J Fertil Steril. 2016; 10:11–21.
34. Tang Y, Zhao M, Lin L, Gao Y, Chen GQ, Chen S, et al. Is body mass index associated with the incidence of endometriosis and the severity of dysmenorrhoea: a case-control study in China? BMJ Open. 2020; 10:e037095.
Article
35. McCann SE, Freudenheim JL, Darrow SL, Batt RE, Zielezny MA. Endometriosis and body fat distribution. Obstet Gynecol. 1993; 82(4 Pt 1):545–9.
Article
36. Backonja U, Buck Louis GM, Lauver DR. Overall adiposity, adipose tissue distribution, and endometriosis: a systematic review. Nurs Res. 2016; 65:151–66.
37. Ley CJ, Lees B, Stevenson JC. Sex- and menopause-associated changes in body-fat distribution. Am J Clin Nutr. 1992; 55:950–4.
Article
38. Jasieńska G, Ziomkiewicz A, Ellison PT, Lipson SF, Thune I. Large breasts and narrow waists indicate high reproductive potential in women. Proc Biol Sci. 2004; 271:1213–7.
Article
39. Yi KW, Shin JH, Park MS, Kim T, Kim SH, Hur JY. Association of body mass index with severity of endometriosis in Korean women. Int J Gynaecol Obstet. 2009; 105:39–42.
Article
40. Lafay Pillet MC, Schneider A, Borghese B, Santulli P, Souza C, Streuli I, et al. Deep infiltrating endometriosis is associated with markedly lower body mass index: a 476 case-control study. Hum Reprod. 2012; 27:265–72.
Article
41. Byun J, Peterson CM, Backonja U, Taylor RN, Stanford JB, Allen-Brady KL, et al. Adiposity and endometriosis severity and typology. J Minim Invasive Gynecol. 2020; 27:1516–23.
Article
42. Murray PJ, Wynn TA. Protective and pathogenic functions of macrophage subsets. Nat Rev Immunol. 2011; 11:723–37.
Article
43. Smith KA, Pearson CB, Hachey AM, Xia DL, Wachtman LM. Alternative activation of macrophages in rhesus macaques (Macaca mulatta) with endometriosis. Comp Med. 2012; 62:303–10.
44. Wang Y, Fu Y, Xue S, Ai A, Chen H, Lyu Q, et al. The M2 polarization of macrophage induced by fractalkine in the endometriotic milieu enhances invasiveness of endometrial stromal cells. Int J Clin Exp Pathol. 2013; 7:194–203.
45. Wang Y, Chen H, Wang N, Guo H, Fu Y, Xue S, et al. Combined 17β-estradiol with TCDD promotes M2 polarization of macrophages in the endometriotic milieu with aid of the interaction between endometrial stromal cells and macrophages. PLoS One. 2015; 10:e0125559.
Article
46. Lumeng CN, Bodzin JL, Saltiel AR. Obesity induces a phenotypic switch in adipose tissue macrophage polarization. J Clin Invest. 2007; 117:175–84.
Article
47. Tilg H, Moschen AR. Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat Rev Immunol. 2006; 6:772–83.
Article
48. Silswal N, Singh AK, Aruna B, Mukhopadhyay S, Ghosh S, Ehtesham NZ. Human resistin stimulates the pro-inflammatory cytokines TNF-alpha and IL-12 in macrophages by NF-kappaB-dependent pathway. Biochem Biophys Res Commun. 2005; 334:1092–101.
49. Yokota T, Oritani K, Takahashi I, Ishikawa J, Matsuyama A, Ouchi N, et al. Adiponectin, a new member of the family of soluble defense collagens, negatively regulates the growth of myelomonocytic progenitors and the functions of macrophages. Blood. 2000; 96:1723–32.
Article
50. Bråkenhielm E, Veitonmäki N, Cao R, Kihara S, Matsuzawa Y, Zhivotovsky B, et al. Adiponectin-induced antiangiogenesis and antitumor activity involve caspase-mediated endothelial cell apoptosis. Proc Natl Acad Sci U S A. 2004; 101:2476–81.
Article
51. Kalaitzopoulos DR, Lempesis IG, Samartzis N, Kolovos G, Dedes I, Daniilidis A, et al. Leptin concentrations in endometriosis: a systematic review and meta-analysis. J Reprod Immunol. 2021; 146:103338.
Article
52. Oh YK, Ha YR, Yi KW, Park HT, Shin JH, Kim T, et al. Increased expression of resistin in ectopic endometrial tissue of women with endometriosis. Am J Reprod Immunol. 2017; 78:e12726.
Article
53. Yi KW, Shin JH, Park HT, Kim T, Kim SH, Hur JY. Resistin concentration is increased in the peritoneal fluid of women with endometriosis. Am J Reprod Immunol. 2010; 64:318–23.
Article
54. Takemura Y, Osuga Y, Harada M, Hirata T, Koga K, Yoshino O, et al. Concentration of adiponectin in peritoneal fluid is decreased in women with endometriosis. Am J Reprod Immunol. 2005; 54:217–21.
Article
55. Zendron C, Gonçalves HF, Cavalcante FS, Pereira TR, Evangelista A, Ramos CF, et al. Increased expression of the leptin receptor in human ovaries affected by endometrioma and detection of high levels of leptin in the ovarian endometriomal fluid. J Ovarian Res. 2014; 7:2.
Article
56. Choi YS, Oh HK, Choi JH. Expression of adiponectin, leptin, and their receptors in ovarian endometrioma. Fertil Steril. 2013; 100:135–41e1. –2.
Article
57. Alviggi C, Clarizia R, Castaldo G, Matarese G, Colucci CC, Conforti S, et al. Leptin concentrations in the peritoneal fluid of women with ovarian endometriosis are different according to the presence of a ‘deep’ or ‘superficial’ ovarian disease. Gynecol Endocrinol. 2009; 25:610–5.
Article
58. Hu E, Liang P, Spiegelman BM. AdipoQ is a novel adipose-specific gene dysregulated in obesity. J Biol Chem. 1996; 271:10697–703.
Article
59. Goetz TG, Mamillapalli R, Taylor HS. Low body mass index in endometriosis is promoted by hepatic metabolic gene dysregulation in mice. Biol Reprod. 2016; 95:115.
60. Zondervan KT, Cardon LR, Kennedy SH. The genetic basis of endometriosis. Curr Opin Obstet Gynecol. 2001; 13:309–14.
Article
61. Blundell JE, Cooling J. High-fat and low-fat (behavioural) phenotypes: biology or environment? Proc Nutr Soc. 1999; 58:773–7.
Article
62. Alderman MH 3rd, Yoder N, Taylor HS. The systemic effects of endometriosis. Semin Reprod Med. 2017; 35:263–70.
Article
63. Kvaskoff M, Mu F, Terry KL, Harris HR, Poole EM, Farland L, et al. Endometriosis: a high-risk population for major chronic diseases? Hum Reprod Update. 2015; 21:500–16.
Article
64. Gemmill JA, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Cancers, infections, and endocrine diseases in women with endometriosis. Fertil Steril. 2010; 94:1627–31.
Article
Full Text Links
  • OGS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr