Eating Behaviors and Endometriosis Risk
Mar 26, 2026
Adolescent Purging Behaviors Linked to Increased Endometriosis Risk in Long-Term Cohort Study
Key Points
Highlight:
- Specific disordered eating behaviors in adolescence show divergent associations with endometriosis risk, with purging behaviors linked to increased risk and binge eating showing an inverse association.
Importance:
- The results highlight behavior-specific and temporally defined risk patterns, underscoring adolescence as a key period in disease development and emphasizing the need to disentangle metabolic, hormonal, and psychosocial pathways in endometriosis pathogenesis.
What's Done Here?
- This report details a large prospective cohort study (n=11,773) with up to 25 years of follow-up.
- Repeated assessment of binge eating, self-induced vomiting, and laxative use during adolescence.
- Endometriosis outcomes based on self-report and laparoscopic confirmation.
- Multivariable models adjusted for demographic, anthropometric, menstrual, and mental health factors.
Key Results:
- Self-induced vomiting was associated with a significantly increased risk of endometriosis, particularly for laparoscopically confirmed cases (≈3-fold increase).
- Frequent binge eating was associated with a lower likelihood of endometriosis diagnosis, though results varied by exposure definition.
- Laxative use showed no consistent association with endometriosis risk.
- Associations remained generally consistent after adjustment for body size, menstrual factors, and mental health variables.
Strength and Limitations:
- Strengths include the prospective design, repeated exposure assessment from adolescence, and validation of endometriosis diagnosis.
- Limitations include potential residual confounding, reliance on self-reported behaviors and outcomes, possible diagnostic delay and reverse causation, and limited generalizability due to cohort demographics.
From the Editor-in-Chief – EndoNews
"This study introduces an important and underexplored dimension of endometriosis risk by examining behavioral exposures during adolescence. By analyzing specific eating-related behaviors individually, rather than as a unified construct, the authors identify divergent associations that challenge simplified interpretations of risk.
However, the observed association between self-induced vomiting and increased endometriosis risk warrants careful consideration of reverse causation. Adolescents with early, undiagnosed endometriosis may experience pain, nausea, and gastrointestinal symptoms, which could either be misclassified as disordered eating behaviors or contribute to their development as coping responses. In this context, vomiting may represent an early manifestation of disease burden rather than an etiologic factor.
The contrasting inverse association with binge eating further underscores that these behaviors likely reflect heterogeneous underlying states, including metabolic, psychological, or symptom-driven pathways. Together, these findings emphasize the complexity of interpreting behavioral exposures in relation to a disease characterized by diagnostic delay and variable early presentation.
While the prospective design strengthens temporal assessment, residual confounding and diagnostic bias remain important considerations. Endometriosis diagnosis is contingent upon clinical recognition and surgical confirmation, and both may be influenced by symptom patterns that overlap with the exposures under study.
Overall, the study highlights adolescence as a potentially informative period in the natural history of endometriosis, but also illustrates the need to distinguish risk factors from early disease signals. Future research integrating symptom trajectories, biological markers, and longitudinal behavioral data will be essential to clarify these relationships."
Lay Summary
A new study published in Fertility and Sterility examined whether eating-related behaviors during adolescence are associated with the later development of endometriosis.
The research was led by Audrey J. Gaskins and colleagues and followed more than 11,000 participants over approximately 25 years.
The researchers focused on specific behaviors—binge eating, self-induced vomiting, and laxative use—rather than diagnosed eating disorders.
They found that girls who frequently engaged in self-induced vomiting were more likely to be diagnosed with endometriosis later in life. In contrast, those reporting frequent binge eating showed a lower likelihood of diagnosis, while laxative use did not show a clear relationship.
The study does not establish a cause-and-effect relationship but suggests that different eating behaviors may be linked to endometriosis risk through distinct biological or behavioral pathways.
Possible explanations include effects on hormonal balance, inflammation, or menstrual cycle function, as well as shared underlying factors such as stress or mental health conditions.
The authors note that adolescence may represent an important period during which exposures can influence long-term gynecologic health.
However, further research is needed to clarify mechanisms and to determine whether these associations reflect biological effects, diagnostic patterns, or other confounding factors.
