Are the Previously Reported Risk Factors for Endometriosis Actually Associated With Pain and Infertility Rather Than Endometriosis Itself?

Abstract

Background: Endometriosis is often diagnosed late due to a lack of noninvasive diagnostic tools and the varied presentation of its symptoms. Identifying risk factors for endometriosis is crucial for reducing diagnosis delays, mitigating the disease's impact, and enabling earlier treatment.

Methods: Original and review articles published in English were selected from PubMed and Google Scholar searches up to January 2026. The following keywords were used: endometriosis, pain, infertility, and risk factors. The search was performed using these keywords individually, as well as in combination.

Main findings results: Several previously reported risk factors associated with endometriosis have also been linked to dysmenorrhea, chronic pain, and infertility. These are all major clinical manifestations of the disease. Additionally, some endometriosis risk factors are associated with depression. Mendelian randomization studies have revealed that depression can cause endometriosis, dysmenorrhea, chronic pain, and infertility. However, few previous studies have conducted subgroup analyses based on clinical manifestations to identify endometriosis risk factors.

Conclusion: It is unclear whether the previously reported risk factors are associated with endometriosis itself or with its specific clinical manifestations, such as pain and infertility. Future epidemiological research evaluating potential risk factors should consider heterogeneous endometriosis populations and include appropriate controls.