Clinical features of endometriosis in patients with type 1 diabetes mellitus

Elena V. Misharina, Maria I. Yarmolinskaya
In: Journal of obstetrics and women's diseases · 2025 · vol. 74(6) , pp. 50–60 · doi:10.17816/jowd697539 · W7133601370
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study characterized endometriosis in type 1 diabetes patients, finding reduced ovarian reserve and altered symptom frequencies compared to non-diabetic endometriosis patients.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

The paper studied clinical features of laparoscopically and histologically confirmed endometriosis in women with type 1 diabetes mellitus (T1DM), comparing 79 women with combined disease, 51 with endometriosis alone, 209 with T1DM alone, and 31 healthy reproductive-age controls. Using ultrasound assessment of antral follicle count and serum anti-Müllerian hormone (AMH) measured on menstrual cycle days 2–5, along with glycemic data (HbA1c) in T1DM, the authors found that abnormal uterine bleeding occurred in 31% with both conditions, versus 71% with endometriosis alone, and that pain scores were highest in endometriosis alone. In the combined group, antral follicles and AMH were lower (8 ± 3 and 3.12 ± 1.78 ng/mL) than in T1DM alone, while the largest decreases (4 ± 2 and 0.94 ± 0.4 ng/mL) were reported in endometriosis alone, and deep infiltrative endometriosis was less frequent with T1DM (42% vs 71% without T1DM). The authors state the study had no pre-calculated sample size, which may limit interpretability, and they frame their findings around the possibility of milder or less symptomatic endometriosis in T1DM. This paper is centrally about endometriosis — it analyzes how endometriosis presents clinically and affects ovarian reserve markers in patients with type 1 diabetes mellitus.

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Abstract

BACKGROUND: Endometriosis affects 5–10% of women of reproductive age worldwide. Despite the high prevalence of the disease, its diagnosis is usually delayed for several years and misdiagnosis is common, leading to delay in effective pathogen-based treatment. Early diagnosis and timely treatment of endometriosis are particularly important in patients with type 1 diabetes mellitus, as the longer the disease lasts, the greater the risk of vascular complications and the lower ovarian reserve, thus decreasing the reproductive capacity. AIM: The aim of this study was to analyze the clinical features of endometriosis in patients with type 1 diabetes mellitus allowing for a timely and accurate diagnosis. METHODS: This clinical study included women with endometriosis, type 1 diabetes mellitus, and a combination of the two. The control group consisted of healthy women of reproductive age. The diagnosis of endometriosis was confirmed by laparoscopic surgery and verified by histological examination. Serum anti-Müllerian hormone levels were determined using the immunochemiluminescence method from days 2 to 5 of the menstrual cycle. Glycated hemoglobin levels were measured in patients with type 1 diabetes mellitus. RESULTS: The study included 51 patients with endometriosis, 209 patients with type 1 diabetes mellitus, 79 patients with a combination of these diseases, and 31 conditionally healthy women. In patients with endometriosis combined with type 1 diabetes mellitus, the frequency of abnormal uterine bleeding was 31%, which is higher than in patients with only type 1 diabetes mellitus (11%), but lower than in those with only endometriosis (71%). Dysmenorrhea according to the McGill visual analogue pain scale in patients with endometriosis combined with type 1 diabetes mellitus was 3.9 ± 1.48 points, with endometriosis 7.06 ± 1.27 points, and with type 1 diabetes mellitus 1.2 ± 0.7 points. In patients with endometriosis combined with type 1 diabetes mellitus, there was a decrease in the number of antral follicles (8 ± 3) and anti-Müllerian hormone level (3.12 ± 1.78 ng/ml) compared to patients with type 1 diabetes mellitus (12 ± 4, 3.52 ± 2.0 ng/ml, respectively). The most pronounced decrease in the number of antral follicles (4 ± 2) and anti-Müllerian hormone level (0.94 ± 0.4 ng/ml) was found in patients with endometriosis. The incidence of deep infiltrative endometriosis was higher in patients without diabetes mellitus, occurring in 71% of cases. In patients with endometriosis combined with type 1 diabetes mellitus, it only occurred in 42% of cases. Endometrioid cysts were found in 42% of patients without type 1 diabetes mellitus and in 22% of those with the disease. Repeat surgical interventions were performed in 25% of patients with endometriosis without type 1 diabetes mellitus, compared to only 10% of women with endometriosis combined with type 1 diabetes mellitus. CONCLUSION: Late diagnosis and delayed treatment of endometriosis, which is often asymptomatic when combined with type 1 diabetes mellitus, can lead to a decrease in ovarian reserve and infertility. In patients with type 1 diabetes mellitus, endometriosis should be suspected in the presence of mild pain, abnormal uterine bleeding, decreased anti-Müllerian hormone levels and antral follicle count, and infertility to ensure timely diagnosis and selection of treatment strategies. Diabetic patients require a long period of pre-pregnancy planning in order to compensate for their disease.

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endometriosisdysmenorrheainfertility

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