Endogenous Steroid Hormone Concentrations and Risk of Endometriosis in Nurses' Health Study II

Amy L. Shafrir, Shafrir AL, Fan Mu, Mu F, A. Heather Eliassen, Eliassen AH, Madhavi Thombre Kulkarni, Kathryn L. Terry, Hankinson SE, Susan E. Hankinson, Missmer SA, Stacey A. Missmer
American Journal of Epidemiology · 2022 · vol. 192(4) , pp. 573–586 · doi:10.1093/aje/kwac219 · PMID:36562714 · PMC10404067 · W4312114164
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Higher early follicular-phase estradiol levels, but not testosterone, progesterone, or mid-luteal phase hormones, were associated with an increased risk of endometriosis.

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Abstract

Few studies have assessed the association between endogenous steroid hormone levels and a subsequent diagnosis of endometriosis. We prospectively evaluated premenopausal plasma sex hormone levels and the risk of laparoscopically confirmed endometriosis in a nested case-control study within Nurses' Health Study II. Between blood collection (1996-1999) and 2009, we ascertained 446 women with incident endometriosis and matched them to 878 controls through risk-set sampling. We conducted multivariable conditional logistic regression accounting for matching and confounders to estimate relative risks (RRs) and 95% confidence intervals (CIs). Women with greater early follicular-phase total or free estradiol levels had a nonlinear increased risk of endometriosis (early follicular total estradiol: second quartile vs. first, RR = 2.23 (95% CI: 1.44, 3.47); third quartile, RR = 1.83 (95% CI: 1.16, 2.88); fourth quartile, RR = 1.68 (95% CI: 1.05, 2.68); early follicular free estradiol: second quartile vs. first, RR = 1.63 (95% CI: 1.05, 2.54); third quartile, RR = 2.02 (95% CI: 1.31, 3.12); fourth quartile, RR = 1.04 (95% CI: 0.66, 1.65)). Free testosterone assessed in quartile categories was not associated with endometriosis, although a threshold effect was observed, with a positive association among women in the top 2% of free testosterone levels. Levels of mid-luteal-phase total and free estradiol, follicular and luteal estrone, total testosterone, progesterone, and sex hormone binding globulin were not associated with endometriosis risk. These results support the role of sex steroids in endometriosis etiology, although the relationships suggest complex threshold effects.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (52)

Cited by (3)

SciLite annotations

chemicals 26
steroid hormone steroid estradiol estradiol estradiol testosterone testosterone estradiol estrone testosterone progesterone sex hormone nitrogen alcohol estradiol estrone progesterone testosterone estrone steroid estrogen androgen danazol androgen steroid hormone progestin
organisms 5
noordeloos 2009062 primates human primates rodents

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