Abuse in Childhood and Risk of Endometriosis Open Access

Abstract

Objective: Evidence from epidemiologic studies suggests that early trauma is associated with diseases of the reproductive tract. The aims of this study are to examine the association of physical and sexual abuse occurring in childhood or adolescence and risk of endometriosis.

Methods: I used data collected from the Nurses' Health Study II (NHS II). The NHS II is a prospective cohort study of US nurses aged 25 - 42 at enrollment in 1989. The Nurses' Health study began in September 1989 with a sample of 116,678 registered female nurses from 14 US states. Premenopausal women aged 25 - 42 years at enrollment (1989) filled out questionnaires every two years including a retrospective questionnaire on childhood violence exposure (2001). Multivariable Cox proportional hazards models were applied to calculate relative risks (RR) and 95% confidence intervals (CI).

Results: A total of 60,410 women contributed 766,014 person-years through 2007, among whom there were 1968 incident premenopausal cases of laparoscopically-confirmed endometriosis. 65% of women in the cohort reported at least one abuse exposure. After adjusting for potential confounders, I observed a statistically significant dose-response association between abuse and endometriosis. Compared to those with no reported abuse events (emotional, physical, or sexual), there was a 13% greater risk of endometriosis for women reporting one episode of mild/moderate abuse (CI=1.02-1.26), RR=1.16 (CI=1.01-1.34) for multiple mild events or one severe episode of abuse, RR=1.33 (CI=1.12-1.57) for chronic moderate abuse of a single type, RR=1.34 (CI=1.03-1.27) for chronic severe abuse of a single type, and over a 2-fold increase in risk for those with chronic severe abuse of multiple types (RR=2.09,CI=1.60-2.73) (test for linear trend p<0.0001). Associations were stronger among those who never reported infertility.

Conclusion: Severity and chronicity of child/adolescent sexual and physical abuse was associated with greater risk of endometriosis. Understanding the mechanisms underlying these relations may shed light on the pathophysiology and potential treatment and prevention of endometriosis.

Table of Contents

Introduction 1

Background 4

Methods 10

Results 18

Discussion 22

Figures 28

Figure 1 28

Figure 2 29

Figure 3 30

Tables 31

Table 1a 31

Table 1b 31

Table 2 32

Table 3 33

Table 4 34

Table 5 35

Table 6 36

Table 7 37

Table 8 38

Table 9 39

Table 10a 40

Table 10b 41

References 42

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research Curriculum Program
Degree	MS
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology
Keyword	childhood abuse endometriosis
Committee Chair / Thesis Advisor	Taylor, N, Robert, Department of Gynecology, Wake Forest
Committee Members	McGowan Jr., John E, Emory University Manatunga, Amita, Emory University

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