Early-life exposures and risk of multiple gynecological diseases: evidence from a large community-based study of 272,706 women

Background Early-life exposures may influence long-term reproductive health, but comprehensive population-based evidence remains limited. This study aimed to evaluate the associations between six early-life factors (long-term/recurrent antibiotic use [LRAU], birth weight, multiple birth, breastfeeding, age at menarche and maternal smoking around birth) and the risk of six major non-neoplastic gynecological diseases in adulthood.

This large observational association study used data from 272,706 women derived from the UK Biobank, a population-based cohort resource. Six gynecological disorders—uterine fibroids (UF), polycystic ovary syndrome (PCOS), endometriosis, genital prolapse, female infertility, and premenstrual syndrome (PMS)—were identified from hospital inpatient records, first occurrence records, and self-reports. Multivariable logistic regression was used as the primary analysis to estimate adjusted odds ratios (aORs), with Cox models as supplementary analyses. The primary adjusted model included age at recruitment, ethnicity, educational attainment, Townsend deprivation index, and smoking status. A Bonferroni-adjusted significance threshold of P < 0.0014 was applied.

Among 272,706 women, the prevalence of the six non-neoplastic gynecological diseases ranged from 0.07% for PMS to 8.51% for UF. After Bonferroni correction, LRAU during early life was associated with higher odds of UF, PCOS, endometriosis, genital prolapse, and PMS. Earlier menarche was associated with higher odds of UF, PCOS, endometriosis, and genital prolapse. Maternal smoking around birth was associated with endometriosis, genital prolapse, and PMS. Not being breastfed as a baby was associated with endometriosis and PMS. Birth weight was associated with genital prolapse. Findings were generally consistent across Cox models and sensitivity analyses, although PMS estimates should be interpreted cautiously because of limited cases.

These findings suggest associations between selected early-life factors and adult non-neoplastic gynecological diseases. Some exposures are potentially modifiable, whereas others are non-modifiable. Together, these factors may help identify individuals at higher risk and inform future studies on risk stratification, but their potential preventive implications require further causal validation. Similar content being viewed by others Abbreviations - aOR: - Adjusted Odds Ratio - CI: - Confidence Interval - T1DM: - Type 1 Diabetes Mellitus - EDCs: - Endocrine Disrupting Chemicals - HR: - Hazard Ratio - LRAU: - Long-term/Recurrent Antibiotic Use - OR: - Odds Ratio - PCOS: - Polycystic Ovary Syndrome - PMDD: - Premenstrual Dysphoric Disorder - PMS: - Premenstrual Syndrome - POP: - Pelvic Organ Prolapse - IPTW: - Inverse Probability of Treatment Weighting - SMD: - Standardized Mean Differences - UKB: - UK Biobank - UF: - Uterine Fibroids

We thank all the participants, researchers, and staff who involved in facilitating the UK Biobank study. Funding This work was supported by the National Natural Science Foundation of China (No.82401924 and No.82201812). Author information Authors and Affiliations Corresponding authors Ethics declarations Ethics approval and consent to participate The study protocol was approved by the North West Multi-Centre Research Ethics Committee (Manchester, U.K.). The UK Biobank was approved by the National Health Service National Research Ethics Service (11/NW/0382). All participants from UK Biobank voluntarily provided written informed consent for their involvement in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Jiang, J., Fu, Y., Chen, Y. et al. Early-life exposures and risk of multiple gynecological diseases: evidence from a large community-based study of 272,706 women. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04646-1 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04646-1