Objective To examine the association between structural reproductive anomalies and the risk of endometriosis. Study design This study used data from the Genetic variants, Early Life exposures, and Longitudinal Endometriosis symptoms Study (GELLES), a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH). We included 8563 women from two population-based cohorts (born 1989–95 and 1973–78). Poisson regression with robust error variance was used to estimate relative risks (RRs) and 95% confidence intervals (CIs), adjusting for sociodemographic, lifestyle, and reproductive or health-related factors. Main outcome measures Endometriosis was identified using self-reported data from the GELLES survey and validated against linked health records. Results In both cohorts, structural reproductive anomalies were associated with an increased risk of endometriosis. In the 1973–78 cohort, women with structural anomalies were more likely to have endometriosis, with adjusted RR = 1.88 (95% CI 1.53, 2.30); similar findings were observed in the 1989–95 cohort, 1.63 (1.25, 2.13). In site-specific analyses of the 1973–78 cohort, uterine 1.86 (1.48, 2.35), cervical 1.77 (1.20, 2.62), and vaginal 3.23 (1.39, 7.55) anomalies were each independently associated with a higher risk. Both congenital uterine anomalies 2.48 (1.72, 3.59) and uterine positional variants, such as a retroverted uterus 1.66 (1.25–2.20), were linked with endometriosis. Associations remained consistent, though slightly attenuated, after excluding women with corrective surgery. Conclusions Structural reproductive anomalies are independently associated with a higher risk of endometriosis. Greater clinical awareness and targeted monitoring of reproductive tract anomalies may support earlier recognition and management, potentially reducing disease burden.
We describe trends in the use of menopausal hormone therapy in Denmark, using data on medication sales from all pharmacies, from 1999 to 2025. Between 2001 and 2013, the proportion of females aged 45–64 who purchased systemically-acting menopausal hormone therapies fell from 20% to 4%. After a decade of consistently low use, purchasing of systemically-acting therapies increased in 2024 and was 8% in 2025. Purchasing of locally-acting (i.e., vaginal) therapies increased throughout the study period, from 5% to 11%. We expect these upward trends to continue in response to growing interest as well as guidelines aimed at supporting decision-making.
Objectives Evidence on hysterectomy and the risk of type 2 diabetes is limited, particularly regarding age at surgery. We assessed whether hysterectomy, with or without bilateral oophorectomy, is associated with incident type 2 diabetes, and whether this association is modified by age at surgery. Study design We followed 82,472 women from the E3N-Generations cohort, free of diabetes at baseline in 1992, until 2008 (median follow-up 16 years). Hysterectomy and oophorectomy were modelled as time-dependent exposures. Hazard ratios were estimated using Cox models with age as the time scale, adjusted for lifestyle, metabolic, and reproductive factors. Main outcome measure Incidence of type 2 diabetes. Results During follow-up, 2318 women developed type 2 diabetes. In fully adjusted models, hysterectomy combined with bilateral oophorectomy was associated with a higher risk of type 2 diabetes (hazard ratio 1.23, 95% confidence interval 1.07–1.43) compared with women who underwent neither procedure, whereas hysterectomy alone was not (1.06, 0.91–1.24). Bilateral oophorectomy alone was not associated with the risk of incident type 2 diabetes. The association with hysterectomy and bilateral oophorectomy was strongest among women operated on before age 45 (1.70, 1.35–2.15); it was similarly elevated when the age threshold was changed to 40 (1.54, 1.08–2.20). There was significant heterogeneity by age at surgery for hysterectomy with bilateral oophorectomy (p = 0.001) and for hysterectomy alone (p = 0.010). Conclusions Hysterectomy with bilateral oophorectomy was associated with an increased risk of incident type 2 diabetes, independently of conventional metabolic risk factors. This excess risk was particularly pronounced among women who underwent surgery before age 45.
