Endometriosis and Systemic Lupus Erythematosus: Systematic Review and Meta-analysis

Endometriosis is a chronic gynaecological condition characterized by inflammatory and immune abnormalities. Likewise, these dysfunctions are important hallmarks of systemic lupus erythematosus (SLE), a condition that also has a high prevalence among women in reproductive age. Therefore, we conducted a systematic review and meta-analysis to investigate the association between endometriosis and SLE. We searched Medline and Web of Science for articles published from database inception to March 1, 2021. Random-effects meta-analysis was performed to provide a pooled risk ratio (RR). Individual study quality was evaluated following the National Heart, Lung, and Blood Institute Quality Assessment Tools (NHLBI QAT). From the 225 articles identified through our search, five studies—assessing 152,355 women—were included. Included studies presented an overall poor or fair quality rating. We observed a significant association between endometriosis and SLE (RR = 2.47, 95% confidence interval: 1.33–4.59, P < 0.004, I2 = 54%). Sensitivity analyses stratifying articles by study design demonstrated that the association was significant in cross-sectional and case–control studies (RR = 5.07, 95% confidence interval: 1.42–18.11, P < 0.012), as well as in cohort studies (RR = 2.07, 95% confidence interval: 1.02–4.20, P < 0.044). In spite of the limited quality of included studies, our results suggest the existence of an association between endometriosis and SLE. These findings can aid medical assessment of patients with endometriosis, as well as provide further insights to better understand this gynaecological disorder. Similar content being viewed by others Data Availability The data used in the preparation of the present article will be made available upon reasonable request. Code Availability The script used for statistical analyses in the present work will be made available upon reasonable request.

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We would like to thank Bruna Bellaver from the Universidade Federal do Rio Grande do Sul for helping with the search strategy, as well as for providing orientation regarding the design and conceptualization of the study. Author information Authors and Affiliations Contributions JPF-S and JSCF designed and conceptualized the study. JPF-S performed the literature search. EEM and JPF-S were responsible for study selection. Data extraction was carried out by LPF and MTP. Quality assessment was performed by JPF-S, EEM, LGC, LPF, and MTP. Data analysis was conducted by JPF-S and JSCF. All authors analysed and interpreted the data, as well as had major contributions for manuscript writing and revised the work regarding intellectual content. Corresponding author Ethics declarations Ethics Approval Not applicable because the present work is a systematic review and meta-analysis. Consent to Participate Not applicable. Consent for Publication Not applicable. Competing Interests The authors declare no competing interests. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions About this article Cite this article Ferrari-Souza, J.P., Pedrotti, M.T., Moretto, E.E. et al. Endometriosis and Systemic Lupus Erythematosus: Systematic Review and Meta-analysis. Reprod. Sci. 30, 997–1005 (2023). https://doi.org/10.1007/s43032-022-01045-3 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s43032-022-01045-3