Structural reproductive problems and risk of endometriosis: A population-based cohort study

Dereje G. Gete, Jenny Doust, Sally Mortlock, Grant W. Montgomery, Jason Abbott, Gita D. Mishra
Maturitas · 2026 · vol. 215 , pp. 109176 · doi:10.1016/j.maturitas.2026.109176 · PMID:42950453 · W7223705195
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A population-based cohort study of 8563 women found that structural reproductive anomalies, including uterine and cervical defects, are independently associated with an increased risk of endometriosis.

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Abstract

OBJECTIVE: To examine the association between structural reproductive anomalies and the risk of endometriosis. STUDY DESIGN: This study used data from the Genetic variants, Early Life exposures, and Longitudinal Endometriosis symptoms Study (GELLES), a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH). We included 8563 women from two population-based cohorts (born 1989-95 and 1973-78). Poisson regression with robust error variance was used to estimate relative risks (RRs) and 95% confidence intervals (CIs), adjusting for sociodemographic, lifestyle, and reproductive or health-related factors. MAIN OUTCOME MEASURES: Endometriosis was identified using self-reported data from the GELLES survey and validated against linked health records. RESULTS: In both cohorts, structural reproductive anomalies were associated with an increased risk of endometriosis. In the 1973-78 cohort, women with structural anomalies were more likely to have endometriosis, with adjusted RR = 1.88 (95% CI 1.53, 2.30); similar findings were observed in the 1989-95 cohort, 1.63 (1.25, 2.13). In site-specific analyses of the 1973-78 cohort, uterine 1.86 (1.48, 2.35), cervical 1.77 (1.20, 2.62), and vaginal 3.23 (1.39, 7.55) anomalies were each independently associated with a higher risk. Both congenital uterine anomalies 2.48 (1.72, 3.59) and uterine positional variants, such as a retroverted uterus 1.66 (1.25-2.20), were linked with endometriosis. Associations remained consistent, though slightly attenuated, after excluding women with corrective surgery. CONCLUSIONS: Structural reproductive anomalies are independently associated with a higher risk of endometriosis. Greater clinical awareness and targeted monitoring of reproductive tract anomalies may support earlier recognition and management, potentially reducing disease burden.

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