Endogenous Hormones and Risk of Endometriosis

描述(申请人提供)：子宫内膜异位症，在美国妇科住院的第三大原因，仍然是最神秘的妇科病理之一。由子宫外子宫内膜组织的存在定义，这些植入物对月经周期的荷尔蒙提示做出反应，并像在子宫内一样“出血”。其结果是发展粘连、结疤和疼痛的炎症。体征和症状包括痛经、性交困难、不孕、排尿困难和经期困难。这种疾病的影响可能会使身体和精神虚弱，经常被误诊，治疗选择有限。尽管与子宫内膜异位症相关的发病率和医疗费用很高，但其病因尚未完全阐明，也没有可改变的保护性危险因素被证实。使用从护士健康研究II收集的多达2000例经腹腔镜确诊的子宫内膜异位症病例的数据，这是一项正在进行的前瞻性队列研究，始于1989年的11.6万名女性登记。其中30,000人还在20世纪90年代末提供了血液样本；我们提议进行一项研究，以评估以下假设：a)身体活动更多的女性患子宫内膜异位症的风险较低。B)矛盾的是，童年时期肥胖的女性患子宫内膜异位症的风险较低。C)哺乳期闭经时间较长的女性患子宫内膜异位症的风险较低。D)血浆睾酮水平较高或雌二醇或胰岛素样生长因子水平较低的妇女患子宫内膜异位症的风险较低。所有分析都将控制其他已知的和建议的子宫内膜异位症的危险因素，如月经周期特征、口服避孕药的使用和吸烟。E)此外，我们将在《今日成长研究》中建立子宫内膜异位症的前瞻性调查。2005年，NHSII参与者的女儿年龄从18岁到23岁不等。这提供了一个独特的机会，为未来的前瞻性调查奠定基础，这些前瞻性调查将我们对子宫内膜异位症发病的最早点进行跟踪，因为这些年轻女性自1996年以来一直提供暴露数据。这些分析将提供第一次对体力活动的前瞻性评估，第一次调查儿童的体型或哺乳期闭经，第一次评估内源性激素水平与绝经前妇女发病的这一重要且未被充分研究的原因之间的关系。在我们的年轻队列中建立随访将为青少年子宫内膜异位症的第一个前瞻性研究提供资源。

DESCRIPTION (provided by applicant): Endometriosis, the third leading cause of gynecologic hospitalization in the United States, remains one of the most enigmatic gynecologic pathologies. Defined by the presence of endometrial tissue outside of the uterus, these implants respond to the hormonal cues of the menstrual cycle and "bleed" as they would in the uterus. The consequence is the development of adhesions, scarring, and painful inflammation. Signs and symptoms include dysmenorrhea, dyspareunia, infertility, dysuria, and dyschezia. The effects of the disease can be physically and mentally debilitating with frequent misdiagnoses and limited treatment options. Despite the high morbidity and health care cost associated with endometriosis, its etiology has not been fully delineated, and no modifiable, protective risk factors have been confirmed. Using data on up to 2,000 laparoscopically confirmed incident cases of endometriosis collected from the Nurses Health Study II, an ongoing, prospective cohort study that began when 116,000 women were enrolled in 1989 . 30,000 of whom also provided blood samples in the late 1990s; we propose a study to assess the following hypotheses: a) Women who are more physically active are at lower risk of endometriosis. b) Paradoxically, women who were obese during childhood are at lower risk of endometriosis. c) Women who experienced longer durations of lactational amenorrhea are at lower risk of endometriosis. d) Women with higher plasma levels of testosterone or with lower levels of estradiol or insulin-like growth factors are at lower risk of endometriosis. All analyses will control for other known and suggested risk factors for endometriosis such as menstrual cycle characteristics, oral contraceptive use, and cigarette smoking. e) In addition, we will establish prospective investigation of endometriosis in the Growing Up Today Study . a cohort of daughters of NHSII participants who range in age from 18-23 in 2005. This provides a unique opportunity to lay the groundwork for future prospective investigations that extend our follow-up to the earliest points of endometriosis incidence as these young women have been providing exposure data since 1996. These analyses will provide the first prospective evaluation of physical activity, will be the first to investigate childhood body size or lactational amenorrhea, and will be the first to evaluate the relation between endogenous hormone levels and this important and understudied cause of morbidity among premenopausal women. Establishment of follow-up among our younger cohort will provide resources for the first prospective study of endometriosis among adolescents.