Endometriosis and hypertriglyceridemia: Why do we care about severity and typology?

While plausible mechanisms exist for an association between endometriosis and hypertriglyceridemia, prior studies have shown inconsistent findings, possibly due to the inability to assess endometriosis severity or subtypes.

Among 473 premenopausal individuals undergoing gynecologic laparoscopy, the present study assessed the association between incident endometriosis and non-fasting serum triglycerides.

Participants were recruited (2007-2009) among women undergoing diagnostic or therapeutic laparoscopy or laparotomy (for any indication) and who had no prior endometriosis diagnosis. Endometriosis was categorized using American Society for Reproductive Medicine staging (I-IV). Typology was defined as superficial endometriosis [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DE]. We collected biospecimens, anthropometrics, and self-reported sociodemographics at enrollment, prior to surgery. We evaluated the association between endometriosis diagnosis, stage, typology, and triglyceride concentrations using non-fasting female cutpoints (normal <175mg/dL vs hypertriglyceridemia ≥175mg/dL) via generalized linear models. We also evaluated whether the association differed by menstrual cycle phase.

Among the cohort, 108 women (23%) had hypertriglyceridemia > 175 mg/dL. Overall, endometriosis was not associated with prevalence of hypertriglyceridemia (adjusted prevalence ratio (aPR): 1.24, 95% CI: 0.87, 1.77), after accounting for baseline age, race/ethnicity, marital status, BMI, income, and serum cotinine. However, this varied by stage and type. Women with moderate to severe stage endometriosis had a higher aPR for hypertriglyceridemia, 1.74 (95% CI: 1.03, 2.95), compared to those without endometriosis. DE combined with OE was associated with a 3.59 higher aPR (95% CI: 2.33, 5.54) for hypertriglyceridemia. A pattern emerged showing stronger associations in the follicular phase compared to the luteal phase.

In summary, while no association was observed for overall endometriosis and hypertriglyceridemia, we observed moderate to severe stage endometriosis as well as DE and OE endometriosis was associated with prevalence of hypertriglyceridemia.