Endometriosis subtypes and risk of type 2 diabetes: the Advancing Research on Cardiovascular Health and Endometriosis Study (ARCHES) retrospective cohort study.

Authors

Maggie Fuzak Nunziato, Bin Yan, Karen C Schliep, Leslie V Farland, Michael W Varner, Jenna R Krall, Kathryn Rexrode, Hediyeh Baradaran, Benjamin Brown, Jennifer J Majersik, Jessica Page, Anna Z Pollack

Published in

Diabetologia. Aug 06, 2026. Epub Aug 06, 2026.

Abstract

Endometriosis is a heterogeneous inflammatory condition that may influence long-term metabolic health. Prior studies have reported largely null associations with type 2 diabetes, potentially missing subtype-specific and subgroup heterogeneity. We investigated the association between endometriosis, including clinically relevant subtypes, and incident type 2 diabetes, and assessed effect modification by menopausal status, BMI and history of gestational diabetes mellitus.
We assembled a dynamic population-based cohort of 2,939,364 individuals assigned as female at birth from the Utah Population Database (1996-2021). Endometriosis and subtypes were identified using validated ICD-9/10 codes and modelled as time-varying exposures. Incident type 2 diabetes was ascertained using ICD codes. Cox proportional hazards models with calendar time as the time scale were used to estimate HRs and 95% CIs, adjusting for birth year, birth state, race/ethnicity, age and BMI at cohort entry. Stratified analyses evaluated effect modification by menopausal status, BMI and history of gestational diabetes mellitus.
During a mean follow-up duration of 10.8 years, 99,978 women were diagnosed with endometriosis. Endometriosis was associated with a 46% higher risk of type 2 diabetes compared with no endometriosis (aHR 1.46; 95% CI 1.43, 1.50). Risk varied by subtype, with the strongest associations observed for 'other site' endometriosis (specified site: aHR 2.67; 95% CI 2.51, 2.84; unspecified site: aHR 2.47; 95% CI 2.35, 2.60). Associations were stronger among premenopausal women than postmenopausal women (aHR 1.55; 95% CI 1.50, 1.60) and those with BMI <30 kg/m² than those in higher BMI categories (aHR 2.39; 95% CI 2.34, 2.44), and were present regardless of history of gestational diabetes mellitus.
Endometriosis was associated with increased type 2 diabetes risk, with substantial heterogeneity by subtype and metabolic context. Associations were strongest among individuals who are traditionally considered at lower baseline risk, although these findings should be interpreted cautiously given the potential for residual confounding and detection bias.

PMID:
42560525
Bibliographic data and abstract were imported from PubMed on 06 Aug 2026.

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