{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:23:34Z","timestamp":1790706214340,"version":"4.1.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Evidence for an association between uterine leiomyoma and increased risk of endometriosis is limited by small sample sizes and short follow-up periods. We assessed this association in a large nationwide sample with 14 years of data.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design<\/jats:title>\n<jats:p>Data were sourced from Taiwan\u2019s Longitudinal Health Insurance Database 2000 (LHID2000).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>We identified 31,239 women aged \u226520 years diagnosed with uterine leiomyoma (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] code 218) between Jan 1, 2000 and Dec 31, 2012, who were matched with 124,956 controls (1:4) by 5-year age groups and year of diagnosis. Follow-up was from the date of LHID2000 entry to the first occurrence of endometriosis, loss to follow-up, insurance termination, or until December 31, 2013, whichever was earlier.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>In Cox regression analysis, the adjusted hazard ratio (aHR) for endometriosis in women with uterine leiomyoma was 6.44 (95% CI, 6.18, 6.72) compared with controls. The risk of endometriosis was significantly increased in women with uterine leiomyoma and comorbidities of tube-ovarian infection (aHR 2.86; 95% CI, 1.28, 6.36), endometritis (1.14; 1.06, 1.24), infertility (1.26; 1.16, 1.37), or allergic diseases (1.11; 1.05, 1.17). Having both uterine leiomyoma and endometritis significantly increased the risk of endometriosis (aHR 6.73; 95% CI, 6.07, 7.45) versus having only uterine leiomyoma (6.61; 6.33, 6.91) or endometritis (1.49; 1.31, 1.69). Similarly, having both uterine leiomyoma and infertility significantly increased the risk of endometriosis (aHR 6.95; 95% CI, 6.21, 7.78) versus having only uterine leiomyoma (6.66; 6.38, 6.96) or infertility (1.78; 1.57, 2.02).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A diagnosis of uterine leiomyoma appears to increase the risk of endometriosis. Patients presenting with uterine fibroids should be encouraged to give informed consent for possible simultaneous surgical treatment of endometriosis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0256772","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T17:45:48Z","timestamp":1629999948000},"page":"e0256772","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["Uterine leiomyoma is associated with the risk of developing endometriosis: A nationwide cohort study involving 156,195 women"],"prefix":"10.1371","volume":"16","author":[{"given":"Kent Yu-Hsien","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0002-3208","authenticated-orcid":true,"given":"Chih-Yi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Lam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherry Yin-Yi","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wu-Chou","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,8,26]]},"reference":[{"issue":"6","key":"pone.0256772.ref001","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.2214\/AJR.17.19234","article-title":"Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign 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Stewart","year":"2001","journal-title":"Lancet"},{"issue":"5","key":"pone.0256772.ref005","doi-asserted-by":"crossref","first-page":"492 e1","DOI":"10.1016\/j.ajog.2011.07.008","article-title":"Leiomyoma-related hospitalization and surgery: prevalence and predicted growth based on population trends","volume":"205","author":"ME Wechter","year":"2011","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"pone.0256772.ref006","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1093\/humupd\/dmv030","article-title":"Epidemiological and genetic clues for molecular mechanisms involved in uterine leiomyoma development and growth","volume":"21","author":"AE Commandeur","year":"2015","journal-title":"Hum Reprod Update"},{"issue":"6 Suppl","key":"pone.0256772.ref007","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.fertnstert.2012.08.001","article-title":"Endometriosis: ancient disease, ancient treatments","volume":"98","author":"C 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