Association of endometriosis with body size and figure

Objective: To determine whether body size and perceived figure, both current and historical, are associated with a diagnosis of endometriosis on laparoscopy. Design: Cohort study of consecutively identified patients undergoing laparoscopy for tubal sterilization or as a diagnostic procedure. Setting: Two university-affiliated hospitals. Patient(s): A cohort of 84 women aged 18-40 years. Endometriosis was visualised in 32 cases; 52 women (controls) had no visualized endometriosis, including 22 undergoing tubal sterilization and 30 with other gynecologic pathology. Interventions: None. Main Outcome Measures: Body mass index (BMI, kg/m(2)) from self-report and perception of body figure were compared for their ability to predict case status (diagnosed endometriosis), using logistic regression models. Longitudinal trends in BMI based on perceived figure at 5-year intervals from age 15 years were compared using mixed linear models. Results: Based on self-report, women diagnoses with endometriosis were taller, thinner, and had a significantly lower BMI. In this series, cases were likely to be late maturers (menarche at >= 14 y) and late to initiate sexual activity ( >= 21 y), and they were less likely to be gravid, parous, and a current smoker. Adjusting for age (in years), being tall (height >= 68 in), and parity (yes vs. no), a higher current BMI was statistically protective for a diagnosis of endometriosis, regardless of whether BMI was determined by self-report (adjusted odds ratio [AOR] = 0.88, 95% confidence interval [CI] 0.79-0.99) or from perceived figure (AOR = 0.86, 95% CI 0.75-0.99). For every unit increase in BMI (kg/m(2)), there was an approximate 12%-14% decrease in the liklihood of being diagnosed with endometriosis. In an adjusted repeated measures model, BMI was 21.3 +/- 0.6 kg/m(2) (estimate +/- SE) for women with endometriosis, compared with 23.2 +/- 0.4 kg/m(2) for the controls, a difference over all ages of -1.9 +/- 0.8 kg/m(2.) This is a consistent difference of about 10 lb at every age, assuming an average height of about 64.5 in. Conclusion(s): In a laparoscopy cohort, women diagnosed with endometriosis were found to have a lower BMI (leaner body habits), both at the time of diagnosis and historically. That women diagnosed with endometriosis may have a consistently lean physique during adolescence and young adulthood lends support to the suggestion of there being an in utero or early childhood origin for endometriosis.