Early-life factors, in-utero exposures and endometriosis risk: a meta-analysis

Reprod Biomed Online. 2020 Aug;41(2):279-289. doi: 10.1016/j.rbmo.2020.04.005. Epub 2020 May 14.


This meta-analysis aimed to offer a general picture of the available data on the effects of early-life factors on the risk of developing endometriosis in adult life. An advanced, systematic search of the online medical databases PubMed, EMBASE and CINAHL was limited to full-length manuscripts published in English in peer-reviewed journals up to February 2019. Log of relative risk (RR) was employed to calculate the pooled effect sizes using both fixed and random effects modelling and I-squared tests to assess heterogeneity. Funnel plots were used to investigation publication bias. The meta-analysis was registered in PROSPERO (ID CRD42019138668). Six studies that included a total of 2360 women affected by endometriosis were analysed. The pooled results showed that the risk of developing endometriosis in adult life was significantly increased by being born prematurely (logRR 0.21, 95% CI -0.03 to 0.40), having a low birthweight (logRR 0.35, 95% CI -0.15 to 0.54), being formula-fed (logRR 0.65, 95% CI -0.35 to 0.95) and having been exposed to diethylstilbestrol (DES) in utero (logRR 0.65, 95% CI 0.26 to 1.04. Among intrauterine and early neonatal exposures, prematurity, birthweight, formula feeding and DES were risk factors for the development of endometriosis in adult life.

Keywords: Early life factors; Endometriosis; Epidemiology; In-utero exposures.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Birth Weight*
  • Endometriosis / etiology*
  • Female
  • Humans
  • Pregnancy
  • Prenatal Exposure Delayed Effects*
  • Risk Factors