Any adjustable risk factor for Endometriosis?

Any adjustable risk factor for Endometriosis?

No association is found between alcohol, caffeine, smoking, and physical activity and risk of endometriosis.

Key Points


  • Alcohol, caffeine, smoking, and physical activity are not linked to endometriosis.


  • Authors sought to assess lifestyle factors such as caffeine and alcohol intake, smoking, and physical activity levels reported prior to the diagnosis of endometriosis.

What's done here:

  • The participants of the study were 495 women undergoing gynecologic laparoscopy or laparotomy regardless of clinical indication (42% pelvic pain, 15% pelvic mass, 12% menstrual irregularities, 10% fibroids, 10% tubal ligation, 7% infertility). Women with prior surgically confirmed endometriosis were excluded.
  • Lifestyle factors such as caffeine, alcohol, smoking (serum cotinine), and physical activity were assessed prior to surgery.

Key Results:

  • No associations were found between women with endometriosis and alcohol consumption, caffeine consumption, or smoking (serum cotinine)
  • The association between endometriosis and weekly occurrences of physical activity and total walking, moderate, and vigorous activity was null.
  • Decreased sitting time was slightly associated with a reduced risk of endometriosis.


  • The lack of geographical diversity, the moderate number of participants, the inclusion of participants who were already symptomatic, and self-reported evaluation for alcohol/caffeine intakes and physical activity participation.
  • The general population in the area where the study performed had lower rates of alcohol and caffeine consumption as compared with the rest of the United States.

Lay Summary

Endometriosis is believed to be estrogen and progesterone-dependent. Lifestyle factors such as alcohol/caffeine intake, smoking, and physical activity influence estrogen levels in the body and, therefore, may impact the development of endometriosis.

In the study of Hemmert et al. which has been published in Paediatric and Perinatal Epidemiology, the relationships between caffeine and alcohol intake, smoking, and physical activity levels reported prior to the diagnosis of endometriosis were evaluated.

Four hundred and seventy-three women, ages 18-44 years, who underwent laparoscopy or laparotomy, at 14 clinic sites between 2007- 2009 were enrolled in the study. Women were excluded if they had previously been diagnosed with endometriosis or cancer (except non-melanoma skin cancer), currently breastfeeding for more than 6 months, or had received injectable hormonal treatment within the previous 2 years.

Adjusted risk ratios of endometriosis by caffeine, alcohol, smoking (serum cotinine), and physical activity were estimated, adjusting for age, marital status, education, race/ethnicity, age at menarche, gravidity, BMI, study site, and other lifestyle factors. Exposure assessment of lifestyle factors was conducted via computer-assisted personal interviews approximately 2 months prior to surgery. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form. The Endometriosis, Natural History, Diagnosis and Outcomes (ENDO) study used serum cotinine biomarkers to quantify smoking status in contrast to most of the studies relied on self-reported exposure data.

Caffeine and alcohol intake, serum cotinine, and physical activity were not found to be linked with endometriosis. Total daily sitting time was slightly associated with increased endometriosis risk.

Since researches found inconsistent results to date, more studies are needed to further elucidate the relationship between alcohol (including type), physical activity, and risk for endometriosis prior to endometriosis diagnosis.

Research Source:

alcohol caffeine endometriosis epidemiology physical activity smoking lifestyle


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