A feasibility study to examine the link between lifestyle and environmental exposures and endometriotic phenotype.

RESEARCH QUESTION: Are there differences in lifestyle and environmental exposures, and clinical characteristics between patients with histologically confirmed endometriosis residing in regional and metropolitan locations in Australia, and their impact on phenotype and disease severity?

DESIGN

A retrospective study of patients with histologically confirmed endometriosis and detailed phenotypic mapping willing to participate in a Lifestyle and Environmental Risk Factor questionnaire. Demographic, lifestyle, environmental and clinical factors were compared between patients residing in regional and metropolitan locations in Australia, and between patients presenting with different lesion types.

RESULTS

Body mass index (BMI; mean ± SD 27.16 ± 5.39 and 25.22 ± 4.93, respectively) and exposure to animal and plant toxins (14.0% and 3.0%, respectively; P = 0.0020) and pesticides (20.0% and 6.0%, respectively; P = 0.0059) were higher in regional participants compared with metropolitan participants. Increasing age (mean ± SD 36.26 ± 8.09, 40.84 ± 7.81 and 33.88 ± 8.39, respectively; P < 0.0001), leiomyomata (16.4%, 19.5 and 6.8%, respectively; P = 0.03) and infertility (63.9%, 63.4% and 40.9%, respectively; P = 0.04) were associated with higher rates of deep infiltrating endometriosis (DIE) and ovarian endometrioma (OMA) compared with superficial disease (SUP). Mental and behavioural problems were reported more often in patients with SUP and DIE than OMA (52.4%, 59.2% and 38.1%, respectively; P = 0.01).

CONCLUSIONS

This study suggests significant differences in environmental exposures and lifestyle factors between patients with endometriosis living in regional areas of Australia compared with patients with endometriosis living in metropolitan areas of Australia. These findings emphasize the importance of environmental and lifestyle considerations in understanding the clinical variability of endometriosis.