Mortality risk associated with endometriosis: a systematic review and meta-analysis

INTRODUCTION: Endometriosis is a chronic, estrogen-dependent gynecological disorder affecting approximately 10% of women worldwide that can cause pelvic pain, lead to infertility, and impair quality of life. Whether the condition elevates risk of mortality remains controversial. This systematic literature review and meta-analysis investigated the long-term survival of women with endometriosis. METHOD: Studies reporting mortality among women with endometriosis were identified through PubMed, EMBASE, Web of Science, Scopus, and OpenGrey in accordance with PRISMA recommendations. Pooled data on all-cause mortality and mortality for specific diseases were meta-analyzed using a random-effects model. Heterogeneity was evaluated using the I2 statistic. RESULTS: Women with endometriosis were not at significantly higher risk than the general population of women for mortality related to gynecological cancer (HR 1.56, 95% CI 0.72-3.39), non-cancerous cardiocerebral disease (HR 0.80, 95% CI 0.53-1.23), non-cancerous respiratory disease (HR 0.89, 95% CI 0.20-4.02), accidents/suicide (HR 1.33, 95% CI 0.99-1.79) or all causes combined (HR 1.00, 95% CI 0.82-1.21). CONCLUSION: Endometriosis does not appear to increase risk of all-cause mortality or mortality due to specific diseases. Future research should focus on how interventions or management influence other long-term outcomes, such as quality of life and mental and reproductive health.