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The risk of endometriosis by early menarche is recently increased: a meta-analysis of literature published from 2000 to 2020

Abstract

Purpose

The relationship between menarche age and endometriosis has been studied extensively; however, the results were inconsistent due to differences in study dates, populations, and methodology. The goal of this meta-analysis was to see how different research populations, dates, and types affected the estimated risk of endometriosis in early menarche.

Methods

The terms “endometriosis”, “early menarche”, and other pertinent terms were searched in PubMed, Medline, and Embase. This meta-analysis comprised 16 papers published between 2000 and 2020, with a start year ranging from 1989 to 2017. Random effects were used to examine endometriosis risks in these articles. Study start years, countries, types (case–control and cohort studies), and quality (Newcastle–Ottawa scale, NOS) were all taken into account in further stratified analysis and meta-regression analyses.

Results

Early menarche (< 12 years) was associated with a significant pooled risk of endometriosis with high heterogeneity (OR = 1.34, 95% CI 1.16–1.54, I2 = 72.0%). Stratified analysis showed that this risk was increased in studies started after 2000 (OR = 1.62, 95% CI 0.96–1.35, I2 = 74.4%), compared to those before 2000 (OR = 1.13, 95% CI 1.16–1.54, I2 = 40.7%); additionally, this risk was higher in low-income countries (OR = 2.11, 95% CI 1.55–2.87, I2 = 0%) than in other countries (OR = 1.25, 95% CI 1.09–1.43, I2 = 70.6%). These results were further confirmed by meta-regression analysis (both P values < 0.1). No significant differences were found between different study types and NOS scores.

Conclusion

Our results suggested an increasing risk of endometriosis with early menarche, which was more noticeable in low-income countries. Large-scale studies are warranted.

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Funding

This work was supported by Research Foundation of Shenzhen Baoan Women’s and Children’s Hospital, Jinan University to BL (BAFY 2020005).

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MYL: data collection, data analysis, and manuscript writing. JLN: data collection and data analysis. BL: protocol/project development and manuscript writing/editing.

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Correspondence to Bin Liu.

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404_2022_6541_MOESM1_ESM.jpg

Supplementary file1 Linear analysis between NOS score and log(OR) for 16 included studies. NOS, Newcastle-Ottawa scale. Circle size means the reported OR and its 95% CI. Red Line and grey band means the predicted OR and its 95% CI (JPG 92 KB)

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Supplementary file2 Meta-analysis of included studies presented by the subgroups of study countries: Asia & Africa vs. Europe & Oceania vs. North America (JPG 199 KB)

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Supplementary file3 Meta-analysis of included studies presented by the subgroups of study area: low-income countries vs. others (JPG 172 KB)

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Supplementary file4 Meta-analysis of included studies presented by the subgroups of study type: Case-control studies vs. Cohort studies (JPG 174 KB)

404_2022_6541_MOESM5_ESM.jpg

Supplementary file5 Meta-analysis of included studies presented by the subgroups of NOS score: ≤5 vs. >5. NOS, Newcastle-Ottawa scale (JPG 181 KB)

404_2022_6541_MOESM6_ESM.png

Supplementary file6 Funnel plot of the publication bias in this meta-analyses. (A)Funnel plot with pseudo 95% CI of 16 included studies. (B), Begg’s test for small-study effects (PNG 88 KB)

Supplementary file7 Egger's test for 16 included studies in this meta-analysis (PNG 62 KB)

Supplementary file8 Sensitivity analysis of 16 included studies in this meta-analysis (JPG 205 KB)

404_2022_6541_MOESM9_ESM.jpg

Supplementary file9 Forest plot of the association between early menarche and endometriosis in studies with different quality on the ascertainment of exposure (age at menarche): 2(top), studies with poor quality on the ascertainment of exposure. 1(bottom), and studies with higher quality on the ascertainment of exposure (JPG 179 KB)

404_2022_6541_MOESM10_ESM.jpg

Supplementary file10 Forest plot of the association between early menarche and endometriosis in 13 included studies, when removing 3 studies with inadequately controlled for potential confounders (JPG 164 KB)

Supplementary file11 Quality of included studies using Newcastle-Ottawa scale (PPTX 70 KB)

Supplementary file12 (DOC 48 KB)

Supplementary file13 (DOC 58 KB)

Appendix

Appendix

  1. A.

    PRISMA 2009 CHECKLIST Online Supplementary Material.

  2. B.

    MOOSE CHECKLIST Online Supplementary Material.

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Lu, MY., Niu, JL. & Liu, B. The risk of endometriosis by early menarche is recently increased: a meta-analysis of literature published from 2000 to 2020. Arch Gynecol Obstet (2022). https://doi.org/10.1007/s00404-022-06541-0

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Keywords

  • Endometriosis
  • Early menarche
  • Meta-analysis
  • Low-income countries