Women with endometriosis face 46 per cent higher risk of type 2 diabetes

Analysis of the health records of almost three million women has found that those with endometriosis face a substantially higher risk of type 2 diabetes, with the association strongest among premenopausal women, women without obesity and those with extra-pelvic disease

Women with endometriosis face a 46 per cent higher risk of type 2 diabetes (T2DM) than women without the condition, a large-scale study has found. The research was led by Maggie Fuzak Nunziato, a doctoral candidate in epidemiology at George Mason University’s College of Public Health, Fairfax County, Virginia, USA, together with Dr. Anna Pollack, a professor in the university’s Department of Global and Community Health with their findings coming from data collected under Advancing Research on Cardiovascular Health and Endometriosis Study (ARCHES) run from the University of Utah.

A retrospective cohort study, ARCHES examined existing health records over time, with its analysis drawing on data for 2,939,364 women held in the Utah Population Database between 1996 and 2021, of whom 99,978 had received a diagnosis of endometriosis. The research represents the largest analysis to date of the relationship between endometriosis and T2DM, and it applies a novel subtype-specific approach not used in earlier work.

Previous work generally treated endometriosis as a single condition and found little or no overall link with T2DM. This study instead separated cases by subtype and found that risk varied considerably as a result. Extra-pelvic endometriosis, in which tissue similar to the lining of the uterus develops outside the pelvic cavity, carried the strongest association. Women with this subtype faced almost three times the risk of T2DM found in women without endometriosis. The pattern held for age and body weight too.

Premenopausal women faced a 55 per cent higher risk, compared with a markedly weaker association among postmenopausal women while women without obesity faced more than twice the risk, compared with a 74 per cent higher risk among women with obesity. None of these groups has traditionally been considered at high risk of T2DM.

“Previous studies largely evaluated endometriosis as a single condition and generally reported little or no overall association with T2DM.

“Our findings add to a growing understanding that endometriosis may affect more than reproductive health alone,” said lead author Fuzak Nunziato.

The researchers believe that chronic inflammation associated with endometriosis may play a role in metabolic health though they caution that further research is needed to establish the connection fully.

Endometriosis affects around one in ten women of reproductive age. It occurs when tissue similar to the lining of the uterus grows outside the uterus, which can often cause chronic pelvic pain, infertility and further complications.

The researchers emphasised that the findings demonstrate an association rather than proof that endometriosis causes T2DM. If confirmed by future research, the results could help clinicians to identify women with endometriosis who face a higher risk of T2DM and who might benefit from earlier screening or preventive care.

Further research is needed to clarify the biological mechanisms that connect the two conditions, and to establish whether earlier metabolic screening could improve outcomes for women with endometriosis.

For further reading please visit: 10.1007/s00125-026-06828-w