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

Abstract 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. Methods 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. Results 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). Conclusion 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).