early Menopause

Endometriosis May Increase Risk for Early Natural Menopause

Laparoscopically confirmed endometriosis increases the risk of early natural menopause (ENM) by 50%, according to the results of a population-based study.

In this study, the researchers analyzed data from Nurses’ Health Study II cohort questionnaire responses collected from 1989 through 2015. The age range of the more than 100,000 premenopausal women included in the cohort was 25 to 42 years at baseline or enrollment in 1989 (mean age at baseline, 35 y), and their menopausal status was determined every 2 years. Follow-up continued until onset of ENM, age 45 years, hysterectomy, oophorectomy, cancer diagnosis, death, loss to follow-up, or end of follow-up in May 2017. The cumulative rate of follow-up in the cohort was greater than 90%.

From October 2020 to April 2021, the researchers analyzed data on endometriosis diagnosis, whether the diagnosis was confirmed laparoscopically, and the main outcome measure of the study, which was natural menopause before age 45 years.

They found that during follow-up, 6640 participants had reported having received a diagnosis of endometriosis, 3921 had reported that it was confirmed laparoscopically, and 2542 had reported experiencing ENM.

Laparoscopically confirmed endometriosis was associated with a 50% increased risk for ENM, and the risk was similar after adjustment for race, ethnicity, and anthropometric and behavioral factors. Additional adjustment for reproductive factors yielded a slightly lower but still significant hazard ratio.

Furthermore, women who had never given birth were at greater risk of ENM than those who had given birth. Similarly, women who had never used oral contraceptives were at greater risk of ENM than those who had used oral contraceptives.

As a result, the researchers concluded that women with laparoscopically confirmed endometriosis “may be at a higher risk for shortened reproductive duration, particularly those who were nulliparous or never used oral contraceptives.”


—Ellen Kurek



Thombre Kilkarni M, Shafrir A, Farland LV, et al. Association between laparoscopically confirmed endometriosis and risk of early natural menopause. JAMA Netw Open. 2022:5(1):e2144391. doi:10.1001/jamanetworkopen.2021.44391