According to the World Health Organization, endometriosis affects approximately one in ten women and girls of reproductive age globally. There is no known cause of endometriosis; however, researchers have theorised that experiencing adverse childhood experiences (ACEs) may increase endometriosis risk. ACEs are risk factors for other diseases, including cancer, depression, and diabetes. Additionally, ACEs may facilitate endometriosis development through an altered immune response, as people with endometriosis have altered immune system functioning. In research published in June 2025 in Human Reproduction, Marika Rostvall and colleagues conducted a nationwide prospective cohort study on Swedish women that measured the association between ACEs and endometriosis risk. Having any ACE was associated with a 20% increased risk of endometriosis compared to no ACEs, and having five or more ACEs was associated with a 61% increased risk.
To observe the effects of ACEs and endometriosis risk, this study recruited all women born in Sweden between 1974 and 2001 with two identified biological parents from the Swedish Medical Birth Register. Personal identification numbers were then used to link the participants to Swedish health and administrative registers. Women who were adopted, or who died, emigrated, or received an endometriosis diagnosis before 15 years of age, were excluded. Participants were followed up until the date of an endometriosis diagnosis, emigration, death, or the censoring date (31 December 2020). Endometriosis diagnosis was obtained from the National Patient Register and was defined using the International Classification of Diseases 9th and 10th revision codes. ACEs were identified using multiple register-based indicators using ICD-8, ICD-9, and ICD-10 codes. Some ACEs measured in the analysis included parental substance abuse, familial death, parental separation, and exposure to violence. In total, 1,316,946 participants were included in the study, 24,311 of whom were diagnosed with endometriosis. All examined ACEs, apart from familial death, were associated with an increased endometriosis risk, with exposure to violence having the highest increased risk at 2.4 times higher. Having any ACE was associated with a 20% increased risk of endometriosis, and having more ACEs was associated with increased risk of endometriosis, with those with five or more ACEs having a 61% increased risk. These estimates changed to a 16% and 57% increased risk, respectively, after adjusting for covariates.
This study by Rostvall and colleagues provides evidence of ACEs being risk factors for endometriosis and that a higher ACE burden exacerbates the risk. Therefore, it highlights the importance of child safeguarding, not only to prevent childhood trauma in the first place but also to minimise its long-term effects on adult health and quality of life. Additionally, it provides reasoning to monitor women with ACEs as an at-risk group for endometriosis, to identify endometriosis at earlier stages. GlobalData epidemiologists forecast that in the 16MM (16MM: US, France, Germany, Italy, Spain, UK, Japan, China, Australia, Brazil, Canada, India, Mexico, Russia, South Africa, and South Korea), diagnosed prevalent cases of endometriosis in women ages 12 to 54 years will decrease from 34.7 million cases in 2025 to 34.6 million cases in 2030.
