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Daniel W. Cramer, MD, ScD; Emery Wilson, MD; Robert J. Stillman, MD; Merle J. Berger, MD; Serge Belisle, MD, MSc; Isaac Schiff, MD; Bruce Albrecht, MD; Mark Gibson, MD; Bruce V. Stadel, MD, MPH; Stephen C. Schoenbaum, MD, MPH

JAMA. 1986;255(14):1904-1908.

Abstract
We compared menstrual characteristics and constitutional factors in 268 white women with primary infertility due to endometriosis and in 3,794 white women admitted for delivery at seven collaborating hospitals from 1981 to 1983. Adjusting for confounding factors, including location, age, religion, and education, women with short-cycle lengths (27 days) and longer flow (greater than or equal to one week) had more than double the risk for endometriosis compared with women with longer cycle lengths and shorter duration of flow. There was a trend for increasing risk for endometriosis to be associated with increasing menstrual pain. Adjusting for these menstrual characteristics, we found decreased risk for endometriosis associated with smoking or exercise that was largely confined to women who began either habit at an early age and were heavier smokers or more strenuous exercisers. We conclude that risk for endometriosis may relate to menstrual factors that predispose to greater pelvic contamination with menstrual products and to constitutional factors that influence endogenous hormonal levels.

(JAMA 1986;255:1904-1908)

Author Affiliations
From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston (Drs Cramer and Schiff); the Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington (Dr Wilson); the Department of Obstetrics and Gynecology, George Washington University Medical Center, Washington, DC (Dr Stillman); the New England Fertility and Gynecology Associates, Department of Obstetrics and Gynecology and Charles A. Dana Research Center, Beth Israel Hospital, Boston (Dr Berger); the Department of Obstetrics and Gynecology, Centre Hôpitalier, Université de Sherbrooke (Quebec) (Dr Belisle); the Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver (Dr Albrecht); the Department of Obstetrics and Gynecology, University of Vermont, Burlington (Dr Gibson); the Contraceptive Evaluation Branch, Center for Population Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md (Dr Stadel); and the Office of the Deputy Medical Director, Harvard Community Health Plan, Boston (Dr Schoenbaum).

Footnotes
Reprint requests to Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Dr Cramer).

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