{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:39:59Z","timestamp":1792550399709,"version":"4.5.0"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2019,6,13]],"date-time":"2019-06-13T00:00:00Z","timestamp":1560384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Innovative Medicines Initiative Joint Undertaking","award":["115766"],"award-info":[{"award-number":["115766"]}]},{"name":"Wellcome Trust Investigator Award","award":["204969\/Z\/16\/Z"],"award-info":[{"award-number":["204969\/Z\/16\/Z"]}]},{"DOI":"10.13039\/501100000325","name":"Wellbeing of Women","doi-asserted-by":"publisher","award":["RG2031"],"award-info":[{"award-number":["RG2031"]}],"id":[{"id":"10.13039\/501100000325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Endometriosis is a chronic gynaecological disorder that affects 2\u201310% of women of reproductive age. The aetiology of endometriosis is largely under-explored, yet abnormalities in the immune system have been suggested to explain the origin of ectopic endometrial tissues, and an association between endometriosis and autoimmune diseases has been proposed. Evaluation of current evidence investigating the association between endometriosis and autoimmune diseases from population-based studies will facilitate our understanding of the causes and consequences of endometriosis and provide a reference for better healthcare practices population-wide.<\/jats:p><\/jats:sec><jats:sec><jats:title>OBJECTIVE AND RATIONALE<\/jats:title><jats:p>The aim of this study was to systematically review the literature on population-based studies investigating an association between endometriosis and autoimmune diseases and to conduct a meta-analysis of combinable results to investigate the extent and robustness of evidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>SEARCH METHODS<\/jats:title><jats:p>Four electronic databases were searched (MEDLINE, Embase, Web of Science, and CINAHL) from each database inception date until 7 April 2018. Search terms included a combination of database-specific controlled vocabulary terms and free-text terms relating to \u2018endometriosis\u2019 and \u2018autoimmune diseases\u2019. Study inclusion criteria focused on peer-reviewed published articles that reported an association between endometriosis and autoimmune diseases, excluding case reports\/series, review papers, meta-analyses, organizational guidelines, editorial letters, expert opinions, and conference abstracts. Quality assessment of included studies was performed based on GRADE criteria. Key information of eligible studies was abstracted into a standard form. Meta-analysis was performed for autoimmune diseases with combinable study results from at least three studies investigating an association with endometriosis. For cross-sectional studies and case\u2013control studies, raw data from each study were documented to calculate a Mantel\u2013Haenszel odds ratio with 95% CIs. For cohort studies, an inverse variance probability weighted model was used to pool study results to calculate a rate ratio (a hazard ratio or a standardized incidence rate) with 95% CIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>OUTCOMES<\/jats:title><jats:p>A total of 26 published population-based cross-sectional, case\u2013control, and cohort studies that investigated the association between endometriosis and autoimmune diseases met all eligible criteria and were included in the review. The studies quantified an association between endometriosis and several autoimmune diseases, including systemic lupus erythematosus (SLE), Sj\u00f6gren\u2019s syndrome (SS), rheumatoid arthritis (RA), autoimmune thyroid disorder, coeliac disease (CLD), multiple sclerosis (MS), inflammatory bowel disease (IBD), and Addison\u2019s disease. However, the quality of the evidence was generally poor due to the high risk of bias in the majority of the chosen study designs and statistical analyses. Only 5 of the 26 studies could provide high-quality evidence, and among these, 4 supported a statistically significant association between endometriosis and at least 1 autoimmune disease: SLE, SS, RA, CLD, MS, or IBD.<\/jats:p><\/jats:sec><jats:sec><jats:title>WIDER IMPLICATIONS<\/jats:title><jats:p>The observed associations between endometriosis and autoimmune diseases suggest that clinicians need to be aware of the potential coexistence of endometriosis and autoimmune diseases when either is diagnosed. Scientists interested in research studies on endometriosis or autoimmune diseases should consider the likelihood of comorbidity when studying these two types of health conditions. Well-designed large prospective cohort studies with confounding control and mediation quantification, as well as genetic and biological studies, are needed to generate further insights into whether endometriosis is a risk factor for, or a consequence of, autoimmune diseases, and whether these two types of disorders share pathophysiological mechanisms even if they arise independently. Such insights may offer opportunities for the development of novel non-hormonal medications such as immuno-modulators or repurposing of existing immunomodulatory therapies for endometriosis.<\/jats:p><\/jats:sec>","DOI":"10.1093\/humupd\/dmz014","type":"journal-article","created":{"date-parts":[[2019,3,22]],"date-time":"2019-03-22T12:12:24Z","timestamp":1553256744000},"page":"486-503","source":"Crossref","is-referenced-by-count":349,"title":["The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8760-6720","authenticated-orcid":false,"given":"Nina","family":"Shigesi","sequence":"first","affiliation":[{"name":"Oxford Endometriosis CaRe Centre, Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Oxford, UK"},{"name":"Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Kvaskoff","sequence":"additional","affiliation":[{"name":"CESP, Facult\u00e9 de m\u00e9decine, Universit\u00e9 Paris-Sud, Facult\u00e9 de m\u00e9decine, UVSQ, INSERM, Universit\u00e9 Paris-Saclay, Villejuif Cedex, France"},{"name":"Gustave Roussy, Espace Maurice Tubiana, Villejuif Cedex, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shona","family":"Kirtley","sequence":"additional","affiliation":[{"name":"Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Feng","sequence":"additional","affiliation":[{"name":"Oxford Endometriosis CaRe Centre, Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3961-8572","authenticated-orcid":false,"given":"Hai","family":"Fang","sequence":"additional","affiliation":[{"name":"Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian C","family":"Knight","sequence":"additional","affiliation":[{"name":"Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey A","family":"Missmer","sequence":"additional","affiliation":[{"name":"Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Boston, MA, USA"},{"name":"Boston Center for Endometriosis, Boston Children\u2019s and Brigham and Women\u2019s Hospitals, Boston, MA, USA"},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA"},{"name":"Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilufer","family":"Rahmioglu","sequence":"additional","affiliation":[{"name":"Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0275-9905","authenticated-orcid":false,"given":"Krina T","family":"Zondervan","sequence":"additional","affiliation":[{"name":"Oxford Endometriosis CaRe Centre, Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Oxford, UK"},{"name":"Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian M","family":"Becker","sequence":"additional","affiliation":[{"name":"Oxford Endometriosis CaRe Centre, Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,6,13]]},"reference":[{"key":"2019091012203061700_ref1","first-page":"23","article-title":"Serological testing for celiac disease in women with endometriosis. 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