Analysis of hormonal status and the course of endometriosis in patients with type 1 diabetes mellitus

Elena V. Misharina, A. V. Tiselko, Maria I. Yarmolinskaya
In: Journal of obstetrics and women's diseases · 2025 · vol. 73(6) , pp. 101–115 · doi:10.17816/jowd636594 · W4406924940
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This study found that women with type 1 diabetes and endometriosis had lower anti-Müllerian hormone and vitamin D levels, and progesterone levels comparable to endometriosis patients but lower than controls.

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This prospective clinical study evaluated hormonal status, vitamin D levels (25-hydroxycalciferol), and aspects of the clinical course of endometriosis in 339 women, including groups with type 1 diabetes mellitus (T1D) alone, T1D combined with laparoscopically verified endometriosis, endometriosis alone, and healthy controls. Across three consecutive menstrual cycles, serum anti-Müllerian hormone, gonadotropins, prolactin, and estradiol/progesterone were measured, and T1D participants had glycated hemoglobin assessed; endometriosis severity was stratified by prevalence grades. Compared with other groups, the T1D plus endometriosis group had the lowest vitamin D, while anti-Müllerian hormone was reduced in the endometriosis group relative to other groups; progesterone was lower than controls in all groups, and glycated hemoglobin was higher in T1D participants. Grades III–IV were more common without T1D, and deep infiltrating endometriosis and reoperations were more frequent in the endometriosis-only group, with the paper noting that an asymptomatic preclinical period in T1D could contribute to delayed diagnosis and treatment. This paper is centrally about endometriosis — it analyzes how type 1 diabetes mellitus modifies hormonal status, vitamin D, and the clinical course of endometriosis, including severity features verified by laparoscopy and histology.

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Abstract

Background: Type 1 diabetes mellitus and endometriosis significantly reduce the quality of patient’s life and hinder the implementation of reproductive plans. Studying the features of the clinical course of endometriosis in patients with type 1 diabetes mellitus will help in the development of new effective and safe therapeutic strategies and diagnostic methods. Aim: The aim of this study was to analyze the clinical course of the diseases, hormonal status and blood vitamin D (25-hydroxycalciferol) levels in patients with type 1 diabetes mellitus combined with endometriosis. Materials and methods: This clinical prospective study included 339 women, of whom 79 patients were with type 1 diabetes mellitus combined with endometriosis (mean age 31.7 ± 5.0 years), 51 patients were with endometriosis (mean age 31.4 ± 3.7 years), and 209 patients were with type 1 diabetes mellitus (mean age 30.2 ± 4.9 years). The control group consisted of 31 healthy women of reproductive age. The immunochemiluminescent method was used to determine the blood serum levels of anti-Müllerian hormone, follicle-stimulating hormone, luteinizing hormone, prolactin, and estradiol (days 2–5 of the menstrual cycle), progesterone (days 20–23 of the menstrual cycle) during three consecutive menstrual cycles, and the blood serum level of glycated hemoglobin was also studied in patients with type 1 diabetes mellitus. The diagnosis of endometriosis in all patients was confirmed based on laparoscopic surgery with verification by histological examination. Results: When assessing the levels of gonadotropins, prolactin, and anti-Müllerian hormone in patients with endometriosis, a decrease in blood anti-Müllerian hormone level was noted in comparison with the other study groups. The levels of gonadotropins and prolactin in patients in all of the study groups were comparable. In all of the study groups, the progesterone level on days 20–23 of the cycle was lower than in the control group. The concentration of vitamin D (25-hydroxycalciferol) in the patients’ peripheral blood in all of the study groups was lower compared to the control group, with the minimum value of 16.3 ± 4.1 ng/ml found in the group of patients with type 1 diabetes mellitus combined with endometriosis. In patients with type 1 diabetes mellitus and in those with the disease combined with endometriosis, no differences were found between the age of onset of type 1 diabetes mellitus and its duration, the total daily insulin dose, and the insulin dose per kilogram of the patient’s weight. The glycated hemoglobin level was higher in the group of patients with type 1 diabetes mellitus. When distributing patients by the grades of endometriosis prevalence, it was found that grades III and IV were more common in patients without type 1 diabetes mellitus. The incidence of deep infiltrating endometriosis was higher in the group of patients with endometriosis only, as was the number of reoperations. Conclusions: The asymptomatic preclinical period of endometriosis in patients with type 1 diabetes mellitus may lead to untimely and erroneous diagnosis and delayed treatment of the disease. In patients with type 1 diabetes mellitus onset in puberty and suffering from endometriosis, the risk of vascular complications increases and the ovarian reserve decreases, which requires the implementation of reproductive goals as early as possible. When choosing therapy for endometriosis in patients with type 1 diabetes mellitus, the presence of vascular complications should be taken into account.
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Abstract

Background: Type 1 diabetes mellitus and endometriosis significantly reduce the quality of patient’s life and hinder the implementation of reproductive plans. Studying the features of the clinical course of endometriosis in patients with type 1 diabetes mellitus will help in the development of new effective and safe therapeutic strategies and diagnostic methods. Aim: The aim of this study was to analyze the clinical course of the diseases, hormonal status and blood vitamin D (25-hydroxycalciferol) levels in patients with type 1 diabetes mellitus combined with endometriosis.

Materials and methods

This clinical prospective study included 339 women, of whom 79 patients were with type 1 diabetes mellitus combined with endometriosis (mean age 31.7 ± 5.0 years), 51 patients were with endometriosis (mean age 31.4 ± 3.7 years), and 209 patients were with type 1 diabetes mellitus (mean age 30.2 ± 4.9 years). The control group consisted of 31 healthy women of reproductive age. The immunochemiluminescent method was used to determine the blood serum levels of anti-Müllerian hormone, follicle-stimulating hormone, luteinizing hormone, prolactin, and estradiol (days 2–5 of the menstrual cycle), progesterone (days 20–23 of the menstrual cycle) during three consecutive menstrual cycles, and the blood serum level of glycated hemoglobin was also studied in patients with type 1 diabetes mellitus. The diagnosis of endometriosis in all patients was confirmed based on laparoscopic surgery with verification by histological examination.

Results

When assessing the levels of gonadotropins, prolactin, and anti-Müllerian hormone in patients with endometriosis, a decrease in blood anti-Müllerian hormone level was noted in comparison with the other study groups. The levels of gonadotropins and prolactin in patients in all of the study groups were comparable. In all of the study groups, the progesterone level on days 20–23 of the cycle was lower than in the control group. The concentration of vitamin D (25-hydroxycalciferol) in the patients’ peripheral blood in all of the study groups was lower compared to the control group, with the minimum value of 16.3 ± 4.1 ng/ml found in the group of patients with type 1 diabetes mellitus combined with endometriosis. In patients with type 1 diabetes mellitus and in those with the disease combined with endometriosis, no differences were found between the age of onset of type 1 diabetes mellitus and its duration, the total daily insulin dose, and the insulin dose per kilogram of the patient’s weight. The glycated hemoglobin level was higher in the group of patients with type 1 diabetes mellitus. When distributing patients by the grades of endometriosis prevalence, it was found that grades III and IV were more common in patients without type 1 diabetes mellitus. The incidence of deep infiltrating endometriosis was higher in the group of patients with endometriosis only, as was the number of reoperations.

Conclusions

The asymptomatic preclinical period of endometriosis in patients with type 1 diabetes mellitus may lead to untimely and erroneous diagnosis and delayed treatment of the disease. In patients with type 1 diabetes mellitus onset in puberty and suffering from endometriosis, the risk of vascular complications increases and the ovarian reserve decreases, which requires the implementation of reproductive goals as early as possible. When choosing therapy for endometriosis in patients with type 1 diabetes mellitus, the presence of vascular complications should be taken into account. Full Text About the authors Elena V. Misharina The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott Author for correspondence. Email: [email protected] ORCID iD: 0000-0002-0276-7112 SPIN-code: 7350-5674 MD, Cand. Sci. (Medicine) Russian Federation, Saint PetersburgAlena V. Tiselko The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott Email: [email protected] ORCID iD: 0000-0002-2512-833X SPIN-code: 5644-9891 MD, Dr. Sci. (Medicine) Russian Federation, Saint PetersburgMaria I. Yarmolinskaya The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott Email: [email protected] ORCID iD: 0000-0002-6551-4147 SPIN-code: 3686-3605 MD, Dr. Sci. (Medicine), Professor, Professor of the Russian Academy of Sciences Russian Federation, Saint PetersburgReferences - Magliano DJ, Boyko EJ; IDF Diabetes Atlas 10th edition scientific committee. IDF diabetes atlas. 10th edition. Brussels: International Diabetes Federation; 2021. [cited 2024 Nov 28] Available from: https://www.ncbi.nlm.nih.gov/books/NBK581934/ - DiMeglio LA, Evans-Molina C, Oram RA. Type 1 diabetes. Lancet. 2018;391(10138):2449–2462. doi: 10.1016/S0140-6736(18)31320-5 - Norris JM, Johnson RK, Stene LC. 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