Is endometriosis associated with infection-related diseases? Insights from a multicenter matched case-control study

Background Endometriosis is an inflammatory disorder characterized by ectopic endometrial-like tissue and affects approximately 5–10% of reproductive-age women. Common symptoms include pelvic pain, infertility and fatigue. Until today the aetiology and the pathogenesis are not fully understood. Chronic inflammation and a dysregulation of the immune system are gaining more attention on their role in the development of and therapeutic approach against endometriosis, possibly pointing towards immunology-related comorbidities in affected women. The objective of this study was to determine whether there is an association between endometriosis and endometriosis symptoms, and selected infection-related symptoms as well as diseases with suspected immune pathogenesis.

This multicenter, retrospective observational study included 568 women with histologically confirmed endometriosis matched by age (± 3 years) to 568 controls without endometriosis. Endometriosis diagnoses were surgically and histologically confirmed.

After adjustment for potential confounders, endometriosis was significantly associated with the reported frequency of flu-like infections (OR 5.678 for the category “frequent/very frequent” versus “never”, p = 0.001). In a subgroup analysis of women with endometriosis, infection susceptibility did not correlate with rASRM stage but was associated with a greater number of endometriosis surgeries (p = 0.0038) and a slightly increased pain intensity (p = 0.03).

This study identified an association between endometriosis and increased frequency of participant-reported, possibly infection-related symptoms, particularly flu-like symptoms. These findings are consistent with the concept of endometriosis as a systemic inflammatory disease and underline the importance of considering infectious and immune comorbidities in the clinical management of endometriosis. Trial registration The study was registered at ClinicalTrials.gov (NCT 02511626, first submitted 2015-07-20). Similar content being viewed by others

We thank all participating women for their willingness to participate in this study, sharing their important experiences to further improvement of management for endometriosis patients. Funding Open access funding provided by University of Zurich. This study did not receive any additional funding. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate The project received approval from the ethical committee of the Canton of Zurich, Switzerland (reference number: StV-Nr. 05/2008) and the ethics boards of all participating hospitals. The study was registered at ClinicalTrials.gov (NCT 02511626). Written informed consent was requested from all participants. This trial was conducted in accordance with the Declaration of Helsinki. Consent for publication not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. About this article Cite this article Niggli, A., Hubert, B., El-Hadad, S. et al. Is endometriosis associated with infection-related diseases? Insights from a multicenter matched case-control study. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04871-8 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04871-8