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Adult Physical Activity and Endometriosis Risk

Vitonis, Allison F.a; Hankinson, Susan E.b,c; Hornstein, Mark D.a; Missmer, Stacey A.a,b,c

doi: 10.1097/EDE.0b013e3181c15d40
Physical Activity: Original Article

Background: Regular exercise has been associated with a 40%–80% reduction in risk for endometriosis in several case-control studies. However, women experiencing symptoms prior to their diagnosis may be less likely to exercise than healthy controls, thus biasing the observed association.

Methods: Using data collected from the Nurses' Health Study II, a prospective cohort study of premenopausal US nurses that began in 1989, we have attempted to clarify this relation. Data are updated every 2 years with follow-up for these analyses through 2001. In 1989, 1991, and 1997 women reported average amount of time per week engaging in various physical activities. A metabolic equivalent (MET) score was assigned to each activity, and these were summed to estimate total activity.

Results: A total of 102,197 premenopausal women contributed 996,422 person-years of follow-up with 2703 cases of laparoscopically confirmed endometriosis. After adjusting for BMI at age 18, current BMI, smoking, parity, infertility status, oral contraceptive use, age at menarche, and menstrual cycle length and pattern in college, we observed only a slight reduction in the incidence of endometriosis, comparing the highest level of activity (≥42 MET hours/week) to the lowest (<3 MET hours/week) (rate ratio = 0.89 [95% confidence interval = 0.77–1.03]). The association was limited to participants with no past or concurrent infertility (P = 0.002, test for heterogeneity). No associations were seen with inactivity.

Conclusions: In this first prospective assessment, we did not find evidence of the strong inverse association previously reported, although we cannot rule out a modest inverse association.

From the aDepartment of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; bChanning Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and cDepartment of Epidemiology, Harvard School of Public Health, Boston, MA.

Submitted 16 April 2009; accepted 11 May 2009; posted 9 November 2009.

Supported by NICHD grants (HD48544 and HD52473), NIH grant (CA50385), and the Eleanor and Miles Shore 50th Anniversary Scholars in Medicine Fellowship.

Correspondence: Allison Vitonis, Ob/Gyn Epidemiology Center, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.