Is there an increased risk of endometriosis or adenomyosis in women with autoimmune disorders, such as Systemic Lupus Erythematosus (SLE) or Rheumatoid Arthritis (RA)?

From the Guidelines

There is a potential increased risk of endometriosis and adenomyosis in women with autoimmune disorders, although the provided evidence does not directly address this relationship. The available evidence focuses on the management of reproductive health in patients with rheumatic and musculoskeletal diseases, including systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) 1. While these studies do not specifically investigate the risk of endometriosis and adenomyosis in women with autoimmune disorders, they highlight the importance of considering the interplay between autoimmune conditions and reproductive health. Key points from the guidelines include:

• The importance of preconception counseling and risk stratification for women with SLE and/or APS 1
• The need for careful management of disease activity and medication use during pregnancy 1
• The potential for pregnancy-related changes to impact manifestations of rheumatic and musculoskeletal diseases 1 Given the complexity of autoimmune disorders and their potential impact on reproductive health, it is essential for women with these conditions to discuss their individual risks and management options with their healthcare provider. Early diagnosis and treatment of endometriosis and adenomyosis, as well as careful management of underlying autoimmune disorders, can help improve outcomes and quality of life for affected women. However, the current evidence does not provide a clear answer to the question of whether there is an increased risk of endometriosis and adenomyosis in women with autoimmune disorders, highlighting the need for further research in this area.

From the Research

Association between Endometriosis and Autoimmune Disorders

• Endometriosis is a chronic gynaecological disorder that affects 2-10% of women of reproductive age, and its aetiology is largely under-explored 2.
• Abnormalities in the immune system have been suggested to explain the origin of ectopic endometrial tissues, and an association between endometriosis and autoimmune diseases has been proposed 2.
• A systematic review and meta-analysis found that endometriosis commonly co-occurs with autoimmune diseases, including systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), rheumatoid arthritis (RA), autoimmune thyroid disorder, coeliac disease (CLD), multiple sclerosis (MS), inflammatory bowel disease (IBD), and Addison's disease 2.
• The observed associations between endometriosis and autoimmune diseases suggest that clinicians need to be aware of the potential coexistence of endometriosis and autoimmune diseases when either is diagnosed 2.

Endometriosis and Immune Dysfunction

• Chronic inflammation is a hallmark feature associated with the development and progression of endometriosis 3.
• Data shows that endometriosis involves the implantation and proliferation of ectopic endometrial cells, which triggers local and systemic inflammation and fibrosis 3.
• Immune dysfunction likely contributes to the pathogenesis of endometriosis, and specific innate and adaptive immune system drivers of endometriosis remain to be identified 3.

Adenomyosis and Autoimmune Disorders

• Adenomyosis is a heterogeneous gynaecologic condition with a range of clinical presentations, and its relationship with autoimmune disorders is not well-established 4.
• There is no direct evidence to suggest an increased risk of adenomyosis in women with autoimmune disorders, but hormonal treatments used to manage adenomyosis symptoms may also be used to treat autoimmune disorders 4.

Prevalence of Autoimmune Disorders in Women

• Autoimmune disorders occur at a rate of 2 to 1 in women, and many autoimmune disorders tend to affect women during periods of extensive stress or hormonal change 5.
• The exact mechanism of autoimmune conditions is not well understood, but it is presumed to vary amongst the disorders 5.
• A greater number of women are affected every year with autoimmune diseases, leading to researchers attempting to identify the underlying factors responsible for this disparity 5.