Endometriosis is usually discussed in terms of pelvic pain, periods and fertility. A study involving health records from nearly 3 million women suggests the condition may deserve a wider lens.
Researchers found that women diagnosed with endometriosis were more likely to later develop type 2 diabetes than women without the diagnosis. The association was particularly notable among premenopausal women and those without obesity — groups that may not always be viewed as obvious candidates for early diabetes screening.
The study cannot prove that endometriosis causes diabetes. But it adds to a growing effort to understand endometriosis as a whole-body inflammatory condition rather than a problem confined to the reproductive organs.
Endometriosis involves tissue, hormones and inflammation
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, commonly around the ovaries, fallopian tubes and other pelvic structures. Symptoms vary enormously: some people have severe pain or infertility, while others have few obvious symptoms.
Inflammation is part of the disease biology, and researchers have increasingly examined whether endometriosis is associated with cardiovascular, autoimmune and metabolic conditions as well as reproductive problems.
The new study does not redefine endometriosis, but it reinforces the idea that a disease centered in the pelvis can have biological connections elsewhere in the body.
The study included nearly 100,000 women with endometriosis
An NIH-funded team analyzed electronic health records from almost 3 million women living in Utah between 1996 and 2021, according to the National Institutes of Health. Nearly 100,000 received an endometriosis diagnosis during the study period.
Overall, women with endometriosis were 46% more likely to develop type 2 diabetes. The association was stronger among women who had not reached menopause and among those with a body mass index below 30.
Researchers also examined where endometriosis was documented. A mixed “other site” category, which could include disease outside the pelvis, was associated with particularly elevated diabetes risk.
The size of the dataset makes the association difficult to dismiss, but a large observational study still cannot tell us whether endometriosis itself produced the higher diabetes risk.
Why might the two conditions be connected?
One possibility is shared inflammation. Chronic inflammatory signaling can affect insulin sensitivity and metabolism, while inflammation also plays an important role in endometriosis. Hormonal factors may be relevant as well.
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But there are other explanations researchers must consider. People with endometriosis may differ in medication use, health-care contact, surgery, physical activity or other factors that could influence diabetes diagnosis or risk. Electronic health records also depend on conditions being recognized and coded accurately.
There is also an important diagnostic wrinkle. Endometriosis can take years to diagnose, and people with milder or atypical disease may never receive a formal diagnosis at all. That means health-record studies can compare groups that are imperfectly defined. The researchers’ findings are still valuable, but future prospective studies could measure metabolic risk factors directly and follow participants from earlier in life.
A plausible biological explanation strengthens a hypothesis; it does not prove the pathway. The next step is to determine which mechanisms, if any, actually connect endometriosis with metabolic disease.
The screening question may be the most immediately useful
Type 2 diabetes risk is commonly assessed using factors such as age, family history, weight and previous gestational diabetes. The new findings suggest endometriosis could eventually help clinicians identify some women who warrant earlier attention to metabolic health.
The researchers specifically noted that premenopausal women without obesity are often considered at lower diabetes risk, yet the association with endometriosis was stronger in these groups. That does not mean everyone with endometriosis suddenly needs intensive testing; screening recommendations require evidence about benefits, harms and cost as well as statistical risk.
For patients, the useful message is not “endometriosis means diabetes,” but that endometriosis may contain health information clinicians have historically overlooked.
Final word
Endometriosis has long been underdiagnosed and sometimes minimized as simply painful periods. Research like this expands the conversation by asking what the condition might tell us about long-term health beyond pain and fertility.
The finding needs replication in other populations, and researchers still have to untangle causation from shared risk factors and health-care patterns. Yet the study’s scale makes the metabolic connection worth investigating.
The broader lesson is that reproductive health is not separate from the rest of health — and conditions that begin in one organ system can offer clues about risks elsewhere.
If you have endometriosis, has a doctor ever discussed metabolic or cardiovascular health as part of your long-term care?
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