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Endometriosis Linked to Inflammatory Bowel Disease


If you are a woman who has been diagnosed with endometriosis, a new study suggests you are twice as likely to develop inflammatory bowel disease (IBD) compared with women who don’t have the gynecologic disorder. In addition, the risk is not a fleeting one: it lingers for about two decades.

Endometriosis can be a life-altering condition

Endometriosis is a condition in which the cells from the lining of the uterus—endometrium—collect and grow outside the uterus, including but not limited to the ovaries, bowel, and pelvic area. Approximately 176 million women around the world suffer with this condition and its most common symptom—pelvic pain—which is debilitating for some women and completely disrupts their lives.

The pelvic pain is often, but not always, is associated with a woman’s menstrual cycle and can be experienced before, during, or after menstruation, during ovulation, when urinating, and during or after sexual intercourse. Other symptoms may include diarrhea or constipation, abdominal bloating, fatigue, and infertility (this latter symptom affects about 30-40% of women with endometriosis).

In this new study, results of which appear in the latest issue of Gut, Danish researchers evaluated data from 37,661 women who had been hospitalized with endometriosis between 1977 and 2007. During that time, 320 women developed inflammatory bowel disease: 228 had ulcerative colitis and 92 had Crohn’s disease.

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Analysis of the data showed that having endometriosis increased a woman’s risk of developing IBD by 50 percent compared with the general population. When the researchers limited their analysis to women who had had their endometriosis verified surgically, the risk rose to 80 percent and lingered for more than two decades after their initial diagnosis.

What’s the link between endometriosis and IBD?

Both endometriosis and inflammatory bowel disease involve chronic inflammation, impact the bowel, and cause abdominal pain. It has also been suggested by some experts that endometriosis is associated with autoimmune diseases such as systemic lupus erythematosus and multiple sclerosis. IBD also is an autoimmune disease.

One possible cause of endometriosis is retrograde menstruation, which, although common in all women, may present a problem in women who have some immune system impairment, such as is seen in autoimmune conditions. It has also been proposed that endometriosis is itself an autoimmune disorder because it presents certain characteristics, such as elevated levels of autoantibodies and peritoneal inflammation.

The authors also noted the increased risk of IBD associated with endometriosis may be due to the use of oral contraceptives, which is a treatment for the gynecologic condition. In fact, research has shown an association between use of oral contraceptives and development of IBD.

For women who have endometriosis and the doctors who care for them, the take-home message from this study is that “a diagnosis of either endometriosis or IBD should not lead to the other diagnosis being disregarded and, hence, should not disqualify further clinical examination of patients with persisting abdominal or gynecological symptoms.”

Cornish JA et al. American Journal of Gastroenterology 2008; 103:2394e400
Jess T et al. Gut 2011. DOI: 10.1136/gutjnl-2011-301095
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