The World Health Organization defines obesity as abnormal or excessive accumulation of fat that poses a health risk. Obesity is a chronic condition that has a negative impact on the quality of life and increases the risk of comorbidities, some of which are quite serious.
There is no definite link between obesity and endometriosis, but there are studies that mention obesity as one of the risk factors for endometriosis. Among them are studies that show that women with endometriosis who are obese have a severe degree of endometriosis.
One such study was conducted in Australia on 700 women surgically diagnosed with endometriosis. The study’s findings showed that although the incidence rate of endometriosis in obese women is lower compared to those of normal weight, they have a higher risk of having severe endometriosis.
But there are also studies that suggest that for every 5 kg/m2, the risk of developing endometriosis is reduced by 33%. This is a meta-analysis, including a quantitative investigation of 11 studies, entitled “What is the link between endometriosis and obesity?”, and was conducted in Korea. The study’s authors suggest, however, that women with a high BMI are less likely to be recommended for surgery for pelvic pain, thereby reducing the chances of endometriosis being diagnosed laparoscopically.
Another study conducted in Australia, published in 2022 in Obesity Research & Clinical Practice, to see if there is a link between body mass index and endometriosis diagnosis, which analysed data from 11,794 young women, the findings show that overweight women had a lower risk of confirmed endometriosis compared to women of normal weight. On the other hand, the risk of clinically suspected endometriosis was higher among overweight women compared to those of normal weight.
Cause or effect?
Although an exact cause between obesity and endometriosis has not yet been established, certain aspects of endometriosis can lead to weight gain. Menopause-inducing hormone treatments often recommended for endometriosis can have the side effect of either weight gain or make weight loss difficult. Specifically, in menopause, estradiol, the hormone that helps regulate metabolism and body weight, decreases. Lower estradiol levels can lead to weight gain.
The risks of obesity
One of the risks of obesity for women is the impact on fertility. Being overweight leads to hormonal dysregulation but also to high levels of androgens, which combined can cause a dysfunction of the secretion of hypothalamic gonadotropin hormones, resulting in a reduction in the number of follicles, as well as the level of progesterone.
Intra and postoperative risks
Being overweight increases the risks associated with surgery often required for endometriosis. Obesity is a significant risk factor for wound infection, blood loss, and longer operative time. Recovery can be more difficult and lengthy, and hospitalisation can also be longer.