reproductive factors have been constantly related with possibility for
endometriosis, signifying that hormonal variation may have a significant influence
on the risk of developing endometriosis.

For Example,
early age at menarche 10, 11, 12, 13, 14 and short menstrual cycle length 13,14
are correlated with an increased chance, while parity 13 and current oral
contraceptives 15 use are associated with a decreased risk. Circulating
estradiol and estrone, which stimulate ectopic and eutopic endometrial tissue,
are higher among women at an earlier age of menarche and in nulliparous women 16-20. Though not a reproductive risk
factor, a consistent inverse association has also been observed between body
mass index (BMI) and endometriosis 10, 11–12, 14, 58, 59 and may also relate to hormonal
differences between heavy and lean women. Unfortunately, the evaluation of
tubal ligation, parity, and oral contraceptive use in relation to endometriosis
risk has been plagued by methodologic issues. Tubal ligation has been
hypothesized to decrease endometriosis risk through blocking retrograde
menstruation from reaching the pelvic cavity. However, the association between
tubal ligation and endometriosis is difficult to interpret since endometriosis
is characterized by infertility, and women who seek a tubal ligation are more
likely to be parous than the general population 21, 22. The mean age at diagnosis is 25–29
years, but it is often greater in women who present with infertility rather
than pelvic pain. 23 Although the mechanism is unknown,
circulating estrogens are known to
be lower in women who smoke 37 and could inhibit the growth and persistence of endometriotic
tissue. The association between alcohol
and caffeine consumption is similarly
mixed and may depend on fertility status. Among infertile women, several
studies have reported increased risk with higher alcohol or caffeine intake 54, 55. The association between physical activity and
endometriosis is unclear 33, higher intake of long-chain omega-3 fatty acids has been
associated with reduced endometriosis risk 44.



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