Association Between Body Fat Percentage and Endometriosis Severity Based on American Association of Gynecologic Laparoscopists 2021 Endometriosis Classification

Milla H, Ritonga MA, Bayuaji H, Heriyanto A, Direza FH
In: International Journal of Women's Health, Vol Volume 18, Iss Issue 1, Pp 1-9 (2026) · 2026 · W7130490104
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This cross-sectional study found a significant inverse association between body fat percentage and endometriosis severity classified by the AAGL 2021 system, alongside similar relationships for BMI, waist-hip ratio, and mid-upper arm circumference.

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This cross-sectional study investigated the relationship between body composition metrics and endometriosis severity in women aged 20 to 45 undergoing laparoscopic surgery. Researchers analyzed data from patients at Hasan Sadikin Hospital to determine correlations between body fat percentage, body mass index, waist-hip ratio, and mid-upper arm circumference against the American Association of Gynecologic Laparoscopists 2021 classification stages. The analysis revealed a significant inverse association between body fat percentage and endometriosis stage, with higher adiposity measurements correlating with less severe disease classifications. Additionally, the findings linked shorter menstrual cycles associated with high body fat to an increased risk of developing endometriosis. This paper is centrally about endometriosis — specifically examining how various measures of adiposity correlate with disease severity using the AAGL 2021 classification system.

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Abstract

Haidarotul Milla,1 Mulyanusa Amarullah Ritonga,2 Hartanto Bayuaji,2 Agus Heriyanto,1 Fikry Haerusulistio Direza3 1Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Bandung, West Java, Indonesia; 2Endocrinology Reproductive and Fertility Division, Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Bandung, West Java, Indonesia; 3Faculty of Medicine, Padjadjaran University, Bandung, West Java, IndonesiaCorrespondence: Haidarotul Milla, Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Pasteur No. 38 Street, Pasteur, Bandung, West Java, 40161, Indonesia, Tel +6281388857911, Email [email protected]: Endometriosis is one of the main reproductive issues that the modifiable risk factors is still the main research focus. It is still unclear how various adiposity affect the onset and spread of endometriosis because some studies have found that there was inverse correlation, while others showed different findings. This study aims to determine the association between body fat percentage (BFP) and the severity of endometriosis in women of reproductive age using American Association of Gynecologic Laparoscopists (AAGL) 2021 Endometriosis Classification.Patients and Methods: This was a cross-sectional analytic design conducted at Hasan Sadikin Hospital from July to October 2025. Some inclusion (endometriosis woman who will undergo laparoscopic surgery with age of 20– 45 years) and exclusion (subject with suspected malignancy) criteria are applied in this study. Statistical analysis was performed to determine the significance of baseline characteristic, body mass index (BMI), waist–hip ratio (WHR), mid-upper arm circumference (MUAC), and BFP towards AAGL endometriosis stage.Results: Our analysis indicates that the baseline characteristic showed no significant differences between the two groups (Mild-Moderate [Stage I–II] vs Severe [Stage III–IV]). Subsequently, this study revealed significant results WHR, MUAC, and BMI with p-values of 0.012, < 0.001, and 0.023, respectively, towards AAGL stage. The study found a significant association between BFP and AAGL stage, with p-values 0.80, and MUAC ≤ 23 cm, but not for MUAC > 23 cm.Conclusion: The study found a significant inverse relationship between BFP and endometriosis stage, with similar results for other measurements like BMI, WHR, and MUAC. In addition, shorter menstrual cycles due to high BFP were also associated with an increased risk of endometriosis.Keywords: endometriosis, body fat percentage, American association of gynecologic laparoscopists, obesity
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International Journal of Women's Health (Feb 2026) Association Between Body Fat Percentage and Endometriosis Severity Based on American Association of Gynecologic Laparoscopists 2021 Endometriosis Classification Abstract Haidarotul Milla,1 Mulyanusa Amarullah Ritonga,2 Hartanto Bayuaji,2 Agus Heriyanto,1 Fikry Haerusulistio Direza3 1Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Bandung, West Java, Indonesia; 2Endocrinology Reproductive and Fertility Division, Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Bandung, West Java, Indonesia; 3Faculty of Medicine, Padjadjaran University, Bandung, West Java, IndonesiaCorrespondence: Haidarotul Milla, Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Pasteur No. 38 Street, Pasteur, Bandung, West Java, 40161, Indonesia, Tel +6281388857911, Email [email protected]: Endometriosis is one of the main reproductive issues that the modifiable risk factors is still the main research focus. It is still unclear how various adiposity affect the onset and spread of endometriosis because some studies have found that there was inverse correlation, while others showed different findings. This study aims to determine the association between body fat percentage (BFP) and the severity of endometriosis in women of reproductive age using American Association of Gynecologic Laparoscopists (AAGL) 2021 Endometriosis Classification.Patients and Methods: This was a cross-sectional analytic design conducted at Hasan Sadikin Hospital from July to October 2025. Some inclusion (endometriosis woman who will undergo laparoscopic surgery with age of 20– 45 years) and exclusion (subject with suspected malignancy) criteria are applied in this study. Statistical analysis was performed to determine the significance of baseline characteristic, body mass index (BMI), waist–hip ratio (WHR), mid-upper arm circumference (MUAC), and BFP towards AAGL endometriosis stage.Results: Our analysis indicates that the baseline characteristic showed no significant differences between the two groups (Mild-Moderate [Stage I–II] vs Severe [Stage III–IV]). Subsequently, this study revealed significant results WHR, MUAC, and BMI with p-values of 0.012, < 0.001, and 0.023, respectively, towards AAGL stage. The study found a significant association between BFP and AAGL stage, with p-values 0.80, and MUAC ≤ 23 cm, but not for MUAC > 23 cm.Conclusion: The study found a significant inverse relationship between BFP and endometriosis stage, with similar results for other measurements like BMI, WHR, and MUAC. In addition, shorter menstrual cycles due to high BFP were also associated with an increased risk of endometriosis.Keywords: endometriosis, body fat percentage, American association of gynecologic laparoscopists, obesity

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