There May Be Some Structural Risk Factors For Endometriosis

Endometriosis can take years to diagnose, especially when painful periods are brushed off as normal. Could the shape or position of a woman’s reproductive organs offer another clue?

A study on endometriosis risk explored this question, looking at differences in the uterus, cervix, and vagina.

Understanding how these anatomical variations relate to endometriosis could eventually help researchers learn more about why some women develop the condition and others don’t.

About the study

Researchers analyzed data from 8,563 women in two Australian birth cohorts, one born between 1973 and 1978 and the other between 1989 and 1995.

Participants reported whether they’d been diagnosed with endometriosis or a structural difference in their reproductive tract.

These differences included variations in the shape or formation of the uterus, as well as changes in its position, such as a uterus that tilts backward instead of forward.

Researchers checked participants’ endometriosis reports against health records and accounted for factors including family history, age at first period, hormone use, and reproductive history.

Reproductive differences were linked to higher risk

Women born between 1973 and 1978 who reported a structural reproductive difference had an 88% higher likelihood of endometriosis. In the younger group, the likelihood was 63% higher.

In the older cohort, uterine differences were associated with an 86% higher likelihood of endometriosis, while cervical differences were linked to a 77% increase. Vaginal differences were associated with more than three times the likelihood, although these were less common.

The type of uterine difference also mattered. Women with congenital uterine anomalies, meaning differences in how the uterus developed before birth, had 2.5 times the likelihood of endometriosis.

Positional differences, such as a retroverted uterus that tilts backward, were associated with a 66% higher likelihood.

These links remained even after researchers excluded women who’d had surgery to correct their anatomical differences.

Why anatomy might be connected to endometriosis

One possible explanation involves retrograde menstruation. This happens when menstrual fluid flows backward into the pelvis rather than leaving the body entirely.

Researchers have long explored this process as one possible contributor to endometriosis, which occurs when tissue similar to the uterine lining grows outside the uterus.

Some reproductive differences may affect menstrual flow, potentially influencing this process. But retrograde menstruation doesn’t explain every case of endometriosis.

The researchers also suggested that genetics or shared early development could play a role.

The uterus, cervix, and vagina develop through related processes before birth, so some anatomical differences and endometriosis risk may have common underlying influences.

Since this was an observational study, it can’t prove anatomical differences cause endometriosis or tell us which develops first. More research is needed to understand the connection.

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What to do if you have a reproductive tract difference

Having a retroverted uterus or another anatomical difference doesn’t mean you’ll develop endometriosis. Still, there are a couple of ways to be proactive about your reproductive health.

• Speak up about persistent symptoms: Painful periods, ongoing pelvic pain, or discomfort that disrupts daily life deserves medical attention. A gynecologist can help assess your symptoms and discuss next steps.

• Ask about your individual risk: If you’ve been diagnosed with a reproductive tract difference, ask your healthcare provider whether it has any implications for your reproductive health.

The takeaway

Your reproductive anatomy may hold clues to endometriosis, but it’s only one piece of a much bigger picture. Knowing about your anatomy can give you and your doctor useful context.