Rates of Premature Ovarian Insufficiency and Surgical Menopause in Patients with Endometriosis

BACKGROUND: Endometriosis is a chronic disorder that affects approximately 10% of reproductive aged women and can have wide-ranging detrimental effects. While endometriosis is known to be associated with early menopause, the rates of primary ovarian insufficiency and surgical menopause in these patients compared to the general population are not well defined. OBJECTIVE: The objective of this study is to evaluate the rates of primary ovarian insufficiency and surgical menopause in patients with a diagnosis of endometriosis. STUDY DESIGN: The TriNetX database was used to identify women 18 and older with surgically diagnosed endometriosis. Diagnostic codes were used to estimate the rates of primary ovarian insufficiency and surgical menopause, which were then tested against a matched comparison group, using propensity score matching to include patients presenting for a routine gynecologic encounter without a diagnosis of endometriosis. Rates were then assessed by age groups: 18-39, 40-44, 45-49. Prevalence of primary ovarian insufficiency and surgical menopause as well as prevalence of oophorectomy and hysterectomy were assessed in patients with a diagnosis of endometriosis from 2013-2023 and stratified by age. RESULTS: Patients with endometriosis had a 3.7x the risk of primary ovarian insufficiency and 12.4x the risk of surgical menopause (p<0.0001), with an overall risk of 1.4% and 0.7%, respectively. Rates of menopause in patients with endometriosis aged 18-39 were 4.7x that of the general population. Reported prevalence proportions of primary ovarian insufficiency and surgical menopause among patients with a diagnosis of endometriosis increased over the past decade, alongside rates of oophorectomy and hysterectomy. The mean annual change in period prevalence were 0.10% (95% CI: 0.09%-0.11%), 1.40% (95% CI: 1.19% ∼ 1.61%), 0.05% (95% CI: 0.04% ∼ 0.06%), 1.97% (95% CI: 1.73% ∼ 2.21%), 0.83% (95% CI: 0.73% ∼ 0.92%) for Premature Ovarian Insufficiency, Menopausal State, Surgical Menopause, Hysterectomy, and Oophorectomy, respectively, during the study period from 2013 to 2023. CONCLUSIONS: Rates of primary ovarian insufficiency and surgical menopause are higher among patients with endometriosis. With higher rates of oophorectomy and hysterectomy at younger ages, adequate counseling on the risks of premature menopause are essential. Further studies are required to guide management of hormone replacement therapy for patients with premature menopause while minimizing endometriosis recurrence. A focus on early diagnosis and preventative strategies is essential to improve the long-term health outcomes for these patients.