Endometriosis: the BMI of young girls heralds the disease?

endometriosis is a chronic disease that affects up to 10% of women of childbearing age worldwide. It is caused by the migration of endometrial tissue outside the uterus. Symptoms include digestive problems, pain in the lower abdomen during sex, extremely unpleasant periods or difficulty getting pregnant. The causes of this affliction are multifactorial, ranging from age, to genetics, to diet (consumption of saturated fatty acids could play a role). According to a new study published on March 3 in the journal Annals of Human Biology On the occasion of the European week of prevention and information on endometriosis, tall and skinny young girls during adolescence would also be more at risk of developing endometriosis later in life.

To reach this conclusion, researchers from the University of Copenhagen and Frederiksberg Hospital (Denmark) examined the BMI of 170,000 women born in Denmark between 1930 and 1996. The height and weight of the participants were were checked between the ages of 7 and 13 or when the girls reached the age of 15. At the same time, the researchers analyzed hospital records for endometriosis or adenomyosis (a related condition) collected between 1997 and 2017. During this time, 2,149 of the study participants were diagnosed with endometriosis, and 1,410 diagnosed with adenomyosis.

The researchers were thus able to notice that the probability of diagnosis was higher in those who had a lower BMI during their childhood. At the age of 13, comparing two young girls of average height, the one who weighs 6.8 kg less has an increased risk of endometriosis of 6%. What’s more, being tall further increases the risks (+9% for girls who are 5.2 cm taller than the average).

“During adolescence, height is an indicator of later risk. It really shows us that the roots of this disease are found earlier in life than people previously thought.”, explains Dr. Jennifer Baker, co-author of the study. According to the researchers, this could be due to levels of estrogen: the hormone increases the size of the lining of the uterus and growth spurts during puberty.

A difficult diagnosis

However, the link with BMI is less clear. “This is a very complex association and there may not be the same pathway between BMI and height”, notes Jennifer Baker who recognizes some limits to her study. Indeed, most of the participants were white. Moreover, since endometriosis is largely under-diagnosed, these studies could only take into account diagnoses recorded in hospitals.

One of the greatest difficulties in the treatment of this disease concerns in particular its recognition by health professionals. It can take between eight and ten years between the appearance of the first symptoms and the diagnosis. To establish the latter, patients often have to undergo an endoscopy, an operation that involves inserting a camera into the abdominal cavity.

Once the disease has been determined, the majority of women are prescribed a continuous pill or a hormone-releasing IUD to prevent the onset of menstruation, which is usually very painful for them. However, these treatments are fraught with side effects. In addition to fertility problems, many sufferers complain of a drastic drop in their libido. Finally, in cases where the disease becomes too extensive, a surgical operation can remove the lesions and make the symptoms disappear for a certain period. The decision will be made with regard to what the patient experiences on a daily basis, her history and her desire for pregnancy.

The results of the BMI study have been released even as March is Endometriosis Awareness Month. Each year, at this time, hundreds of events are organized to raise public awareness of the disease and provide guidance to the millions of women who suffer from it. On Saturday March 28, a global march for endometriosis, named after Endomarchwill take place.