Associations of Endometriosis and Hormone Therapy With Risk of Hyperlipidemia

Am J Epidemiol. 2021 Feb 1;190(2):277-287. doi: 10.1093/aje/kwaa173.


Using claims data from the universal health insurance program of Taiwan, we conducted a retrospective cohort study to investigate whether endometriosis and hormone therapy are associated with the risk of developing hyperlipidemia. We selected 9,155 women aged 20-55 years with endometriosis diagnosed during the period 2000-2013 and 212,641 women without endometriosis with a median follow-up time of 7 years. Among patients with endometriosis, 86% of cases were identified on the basis of diagnosis codes with an ultrasound claim, and 14% were defined by diagnostic laparoscopy or surgical treatments. In a Cox proportional hazards model, the adjusted hazard ratio was 1.30 (95% confidence interval (CI): 1.19, 1.41) for all women, 1.04 (95% CI: 0.81, 1.32) for women under 35 years of age, 1.17 (95% CI: 1.03, 1.32) for women aged 35-44 years, and 1.34 (95% CI: 1.18, 1.52) for women aged 45-54 years. Hysterectomy and/or bilateral oophorectomy accounted for 46.9% of the association between endometriosis and hyperlipidemia, and hormone therapy accounted for 21.6%. Among women with endometriosis, the marginal structural model approach adjusting for time-varying hysterectomy/bilateral oophorectomy showed no association between use of hormone medications and risk of hyperlipidemia. We concluded that women with endometriosis are at increased risk of hyperlipidemia; use of hormone therapy by these women was not independently associated with the development of hyperlipidemia.

Keywords: endometriosis; hormone therapy; hyperlipidemia; women’s health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Endometriosis / drug therapy*
  • Endometriosis / epidemiology*
  • Endometriosis / surgery
  • Estrogen Replacement Therapy / statistics & numerical data*
  • Female
  • Humans
  • Hyperlipidemias / epidemiology*
  • Hysterectomy / statistics & numerical data
  • Middle Aged
  • Ovariectomy / statistics & numerical data
  • Proportional Hazards Models
  • Retrospective Studies
  • Taiwan / epidemiology
  • Women's Health
  • Young Adult