The risk of endometriosis by early menarche is recently increased: a meta-analysis of literature published from 2000 to 2020

Mei-Yin Lu, Jia-Li Niu, Jiali Niu, Niu JL, Bin Liu
Archives of gynecology and obstetrics · 2022 · vol. 307(1) , pp. 59–69 · doi:10.1007/s00404-022-06541-0 · PMID:35377041 · W4225758411
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This meta-analysis of 16 studies from 2000-2020 found that early menarche (< 12 years) is associated with an increased risk of endometriosis, particularly in low-income countries and in studies initiated after 2000.

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This meta-analysis examined whether early age at menarche (<12 years) is associated with endometriosis risk, synthesizing 16 studies published from 2000–2020 (searches in PubMed, Medline, and Embase) and using random-effects models with stratified analyses by country, study start year, study type (case–control vs cohort), and quality (Newcastle–Ottawa scale). The pooled results showed early menarche was associated with a significantly increased risk of endometriosis (OR 1.34, 95% CI 1.16–1.54) but with high heterogeneity (I²=72%). Stratification indicated a more noticeable association in studies started after 2000 and in low-income countries, and meta-regression supported these patterns (P<0.1), while no differences were seen by study type or NOS score. The paper concludes that the risk relationship appears to be increasing and calls for large-scale studies; This paper is centrally about endometriosis — it quantifies how early menarche is associated with endometriosis risk via a meta-analysis.

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Abstract

PurposeThe relationship between menarche age and endometriosis has been studied extensively; however, the results were inconsistent due to differences in study dates, populations, and methodology. The goal of this meta-analysis was to see how different research populations, dates, and types affected the estimated risk of endometriosis in early menarche.MethodsThe terms "endometriosis", "early menarche", and other pertinent terms were searched in PubMed, Medline, and Embase. This meta-analysis comprised 16 papers published between 2000 and 2020, with a start year ranging from 1989 to 2017. Random effects were used to examine endometriosis risks in these articles. Study start years, countries, types (case-control and cohort studies), and quality (Newcastle-Ottawa scale, NOS) were all taken into account in further stratified analysis and meta-regression analyses.ResultsEarly menarche (< 12 years) was associated with a significant pooled risk of endometriosis with high heterogeneity (OR = 1.34, 95% CI 1.16-1.54, I2 = 72.0%). Stratified analysis showed that this risk was increased in studies started after 2000 (OR = 1.62, 95% CI 0.96-1.35, I2 = 74.4%), compared to those before 2000 (OR = 1.13, 95% CI 1.16-1.54, I2 = 40.7%); additionally, this risk was higher in low-income countries (OR = 2.11, 95% CI 1.55-2.87, I2 = 0%) than in other countries (OR = 1.25, 95% CI 1.09-1.43, I2 = 70.6%). These results were further confirmed by meta-regression analysis (both P values < 0.1). No significant differences were found between different study types and NOS scores.ConclusionOur results suggested an increasing risk of endometriosis with early menarche, which was more noticeable in low-income countries. Large-scale studies are warranted.
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Abstract

Purpose The relationship between menarche age and endometriosis has been studied extensively; however, the results were inconsistent due to differences in study dates, populations, and methodology. The goal of this meta-analysis was to see how different research populations, dates, and types affected the estimated risk of endometriosis in early menarche.

Methods

The terms “endometriosis”, “early menarche”, and other pertinent terms were searched in PubMed, Medline, and Embase. This meta-analysis comprised 16 papers published between 2000 and 2020, with a start year ranging from 1989 to 2017. Random effects were used to examine endometriosis risks in these articles. Study start years, countries, types (case–control and cohort studies), and quality (Newcastle–Ottawa scale, NOS) were all taken into account in further stratified analysis and meta-regression analyses.

Results

Early menarche (< 12 years) was associated with a significant pooled risk of endometriosis with high heterogeneity (OR = 1.34, 95% CI 1.16–1.54, I2 = 72.0%). Stratified analysis showed that this risk was increased in studies started after 2000 (OR = 1.62, 95% CI 0.96–1.35, I2 = 74.4%), compared to those before 2000 (OR = 1.13, 95% CI 1.16–1.54, I2 = 40.7%); additionally, this risk was higher in low-income countries (OR = 2.11, 95% CI 1.55–2.87, I2 = 0%) than in other countries (OR = 1.25, 95% CI 1.09–1.43, I2 = 70.6%). These results were further confirmed by meta-regression analysis (both P values < 0.1). No significant differences were found between different study types and NOS scores.

Conclusion

Our results suggested an increasing risk of endometriosis with early menarche, which was more noticeable in low-income countries. Large-scale studies are warranted. Similar content being viewed by others Availability of data and materials Not applicable. Code availability Not applicable.

References

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Ann N Y Acad Sci 955:11. https://doi.org/10.1111/j.1749-6632.2002.tb02761.x Pierce MB, Leon DA (2005) Age at menarche and adult BMI in the Aberdeen children of the 1950s cohort study. Am J Clin Nutr 82:733. https://doi.org/10.1093/ajcn/82.4.733 Funding This work was supported by Research Foundation of Shenzhen Baoan Women’s and Children’s Hospital, Jinan University to BL (BAFY 2020005). Author information Authors and Affiliations Contributions MYL: data collection, data analysis, and manuscript writing. JLN: data collection and data analysis. BL: protocol/project development and manuscript writing/editing. Corresponding author Ethics declarations Conflict of interests The authors have no conflicts of interest to declare. Ethics approval Not applicable. Consent to participate Not applicable. Consent for publication This manuscript is approved by all the authors for publication. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Electronic supplementary material Below is the link to the electronic supplementary material. 404_2022_6541_MOESM1_ESM.jpg (download JPG ) Supplementary file1 Linear analysis between NOS score and log(OR) for 16 included studies. NOS, Newcastle-Ottawa scale. Circle size means the reported OR and its 95% CI. Red Line and grey band means the predicted OR and its 95% CI (JPG 92 KB) 404_2022_6541_MOESM2_ESM.jpg (download JPG ) Supplementary file2 Meta-analysis of included studies presented by the subgroups of study countries: Asia & Africa vs. Europe & Oceania vs. North America (JPG 199 KB) 404_2022_6541_MOESM3_ESM.jpg (download JPG ) Supplementary file3 Meta-analysis of included studies presented by the subgroups of study area: low-income countries vs. others (JPG 172 KB) 404_2022_6541_MOESM4_ESM.jpg (download JPG ) Supplementary file4 Meta-analysis of included studies presented by the subgroups of study type: Case-control studies vs. Cohort studies (JPG 174 KB) 404_2022_6541_MOESM5_ESM.jpg (download JPG ) Supplementary file5 Meta-analysis of included studies presented by the subgroups of NOS score: ≤5 vs. >5. NOS, Newcastle-Ottawa scale (JPG 181 KB) 404_2022_6541_MOESM6_ESM.png (download PNG ) Supplementary file6 Funnel plot of the publication bias in this meta-analyses. (A)Funnel plot with pseudo 95% CI of 16 included studies. (B), Begg’s test for small-study effects (PNG 88 KB) 404_2022_6541_MOESM9_ESM.jpg (download JPG ) Supplementary file9 Forest plot of the association between early menarche and endometriosis in studies with different quality on the ascertainment of exposure (age at menarche): 2(top), studies with poor quality on the ascertainment of exposure. 1(bottom), and studies with higher quality on the ascertainment of exposure (JPG 179 KB) 404_2022_6541_MOESM10_ESM.jpg (download JPG ) Supplementary file10 Forest plot of the association between early menarche and endometriosis in 13 included studies, when removing 3 studies with inadequately controlled for potential confounders (JPG 164 KB) Appendix Appendix - A. PRISMA 2009 CHECKLIST Online Supplementary Material. - B. MOOSE CHECKLIST Online Supplementary Material. Rights and permissions About this article Cite this article Lu, MY., Niu, JL. & Liu, B. The risk of endometriosis by early menarche is recently increased: a meta-analysis of literature published from 2000 to 2020. Arch Gynecol Obstet 307, 59–69 (2023). https://doi.org/10.1007/s00404-022-06541-0 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-022-06541-0

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Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Menarche Menarche Menarche Menarche Menarche Case-Control Studies Case-Control Studies Case-Control Studies Case-Control Studies Case-Control Studies Cohort Studies Cohort Studies Cohort Studies

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