Daijiworld Media Network - New Delhi
New Delhi, Sep 16: Endometriosis, a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus, may have effects beyond the reproductive system, with researchers increasingly examining its possible association with insulin resistance and other aspects of metabolic health.
Endometriosis commonly causes pelvic pain, painful periods and fatigue and, in some cases, can affect fertility. While it is primarily considered a gynaecological condition, growing research is exploring whether chronic inflammation, hormonal changes and alterations in body composition associated with the disease may also influence the body's response to insulin.
However, the evidence linking endometriosis directly to insulin resistance is still evolving. It remains unclear whether endometriosis itself contributes to insulin resistance, whether the association is indirect, or whether factors such as lifestyle, medications and co-existing conditions play a more significant role.
Kanikka Malhotra, Consultant Dietician and Diabetes Educator, said the possible connection is being actively studied.
"Yes, although this connection is still being actively studied. Endometriosis is fundamentally an inflammatory condition, and chronic inflammation is a well-established driver of insulin resistance," Malhotra said.
She added that some research suggests women with endometriosis may have higher markers of insulin resistance and a greater prevalence of metabolic syndrome features, including elevated blood sugar, even when body weight is similar.
However, she noted that the association is not as firmly established as the well-documented relationship between polycystic ovary syndrome (PCOS) and insulin resistance.
"The biological overlap is strong enough that researchers are paying increasing attention to it," she said.
Chronic inflammation is considered one possible factor behind the association. According to Malhotra, inflammatory compounds associated with endometriosis may interfere with insulin signalling, potentially making it more difficult for cells to absorb glucose effectively.
Hormonal changes, including alterations in oestrogen levels, may also influence fat distribution and insulin sensitivity.
Chronic pelvic pain and the emotional burden associated with living with endometriosis may further contribute to the problem. Malhotra said persistent pain and stress can raise cortisol levels, while reduced physical activity due to pain may negatively affect insulin sensitivity.
Some hormonal treatments used to manage endometriosis may also influence metabolic parameters, she added.
"Together, these factors create a complex interaction between inflammation, hormones, stress, physical activity and treatment that can make blood sugar regulation more challenging," Malhotra said.
Endometriosis can remain undiagnosed for years after symptoms first appear. This has prompted researchers to examine whether women living with the condition could also benefit from greater attention to broader metabolic health.
At present, however, the possible association between endometriosis and insulin resistance should not be interpreted as proof that endometriosis directly causes insulin resistance. More research is required to establish the nature and strength of the relationship and to determine which factors may be responsible.