Rates of Primary Ovarian Insufficiency and Surgical Menopause in Patients With Endometriosis

INTRODUCTION: Endometriosis is a chronic disorder that affects approximately 10% of reproductive-aged women and can have wide-ranging detrimental effects. While endometriosis is known to be associated with early menopause, the rates of primary ovarian insufficiency (POI) and surgical menopause (SM) in these patients compared to the general population are not well defined. Additionally, data on the rates of hysterectomy and oophorectomy in patients with endometriosis are limited. Given the known risks of infertility and long-term terms risks associated with early menopause, it is important to evaluate the rates of POI and SM in this population. OBJECTIVE: The objective of this study is to evaluate the rates of primary ovarian insufficiency and surgical menopause in patients with a diagnosis of endometriosis. METHODS: The TriNetX database was used to identify women older than 18 with a diagnosis of endometriosis within 6 weeks of surgery. The rates of POI and SM were then compared against a control population, which included patients presenting for a routine gynecologic encounter without a diagnosis of endometriosis. Propensity score matching was used to balance the cohorts. Prevalence rates of POI and SM as well as rates of oophorectomy and hysterectomy were assessed in patients with a diagnosis of endometriosis from 2013–2023 and stratified by age. RESULTS: Patients with endometriosis had 3.7 × the risk of POI and 12.4× the risk of surgical menopause (p<0.0001), with an overall risk over the follow-up period of 1.4% and 0.7%, respectively. Prevalence rates of POI and SM among patients with a diagnosis of endometriosis have increased over the past decade, alongside increasing rates of oophorectomy and hysterectomy. This increase is evident across younger age groups (Figure 1). CONCLUSIONS: Rates of POI and SM are increasing among patients with endometriosis, likely in part in response to increased diagnosis and earlier management of endometriosis. With increases in oophorectomy and hysterectomy at younger ages, adequate counseling on fertility preservation and the risks of premature menopause is essential. Further studies are required to delineate optimal candidates for fertility preservation and guide the management of hormone replacement therapy for patients with premature menopause while minimizing endometriosis recurrence (Table 1).