Adenomyosis and endometriosis in the California Teachers Study

Templeman, Claire; Marshall, Sarah F.; Ursin, Giske; Horn-Ross, Pamela L.; Clarke, Christina A.; Allen, Mark; Deapen, Dennis; Ziogas, Argyrios; Reynolds, Peggy; Cress, Rosemary; Anton-Culver, Hoda; West, Dee; Ross, Ronald K.; Bernstein, Leslie

doi:10.1016/j.fertnstert.2007.06.027

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Volume 90, Issue 2 , Pages 415-424, August 2008

Adenomyosis and endometriosis in the California Teachers Study

Claire Templeman, M.D.
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, California
- Reprint request: Claire Templeman, M.D., Department of Obstetrics and Gynecology, University of Southern California, Womens and Childrens Hospital, 1240 Mission Road, Room L1009, Los Angeles, CA 90033 (FAX: 323-226-3509).
Sarah F. Marshall, M.A.
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
Giske Ursin, M.D., Ph.D.
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
Pamela L. Horn-Ross, Ph.D.
- Northern California Cancer Center, Fremont, California
Christina A. Clarke, Ph.D.
- Northern California Cancer Center, Fremont, California
Mark Allen, M.S.
- Public Health Institute, Sacramento, California
Dennis Deapen, Dr.P.H.
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
Argyrios Ziogas, Ph.D.
- University of California, Irvine, California
Peggy Reynolds, Ph.D.
- University of California, Irvine, California
Rosemary Cress, Ph.D.
- Public Health Institute, Sacramento, California
Hoda Anton-Culver, Ph.D.
- University of California, Irvine, California
Dee West, Ph.D.
- Northern California Cancer Center, Fremont, California
Ronald K. Ross, M.D.
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
Leslie Bernstein, Ph.D.
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California

Received 27 March 2007; received in revised form 7 June 2007; accepted 7 June 2007. published online 05 October 2007.

Objective

To evaluate the reproductive and lifestyle correlates of a surgically confirmed diagnosis of endometriosis or adenomyosis in a large prospective cohort.

Design

Collection of surgical diagnoses of endometriosis and adenomyosis during follow-up of women with no prior history of endometriosis and no prior surgery for adenomyosis.

Setting

The California Teachers Study (CTS), an ongoing prospective study of female teachers and school administrators established from the rolls of the California State Teachers Retirement System.

Patient(s)

Women with surgical diagnoses of endometriosis and adenomyosis were identified from California statewide hospital patient discharge records for CTS cohort members with an intact uterus and no prior history of endometriosis. Women with an incident surgical diagnosis of endometriosis (n = 229) or adenomyosis (n = 961) were compared with disease-free women in the same age range (for endometriosis, n = 43,493; for adenomyosis, n = 79,495).

Intervention(s)

None.

Main Outcome Measure(s)

Multivariable logistic regression methods were used to calculate prevalence odds ratios and associated 95% confidence intervals for the associations between self-reported menstrual and reproductive characteristics and either endometriosis or adenomyosis.

Result(s)

Women surgically diagnosed with endometriosis were younger than those surgically diagnosed with adenomyosis. Factors statistically significantly associated with endometriosis were having a mother or sister with endometriosis and nulligravidity. Factors statistically significantly associated with adenomyosis were increasing parity, early menarche (≤10 years of age), and short menstrual cycles (≤24 days in length). Obese women also were more likely to have a surgical diagnosis of adenomyosis.

Conclusion(s)

These observations provide the first epidemiologic profile of women with a surgical diagnosis of adenomyosis and indicate that this profile differs from that of women with a surgical diagnosis of endometriosis. Our results also suggest that adenomyosis but not endometriosis is associated with increased endogenous exposure to estrogen.

Key Words: Adenomyosis, endometriosis, epidemiology