Risk Factors

Ancestral Pop.	Endometriosis rates	PCOS rates	Testosterone in pregnancy
Asian	Highest	Lowest	Not mentioned
European	Average	Average	>-
African	Lowest	Highest	Higher than European

Testosterone levels vary in both sexes, which creates a range of “feminine” and “masculine” features in the population. In broad terms, the most feminine women are also the most likely to have endometriosis due to their relatively low testosterone levels.

Finger lengths

Differences in finger length are a way to assess the testosterone levels a person was exposed to in the womb. This is known as the 2D:4D ratio, and the connection between finger length and testosterone is due to two genes determining genital and digit growth in the first trimester. The differences in finger length persist into childhood and adulthood.

The more exposure to testosterone in the womb, the greater the difference in length between the second (index) and fourth (ring) fingers. (The measurement is from the middle of the bottom crease to the tip of the finger).

As a rule, the ring finger in men is longer than their index fingers, while in women, they’re roughly the same length. However, some ethnic variations exist (less difference in Chinese and African populations), but the less difference in finger length, the lower the exposure to testosterone in the womb.

Hormones are crucial to sexual development and fertility, and exposure to environmental chemicals is a significant issue for all ages.

Endocrine-Disrupting Chemicals

As endometriosis is an estrogen-dependant disease, there’s significant scope for Endocrine-Disrupting Chemicals (EDCs)) to accelerate its development and severity. There are currently 1500 recognised EDCs that enter our bodies via food, drinks, lungs and the skin. They can accumulate in fat tissue and persist for long periods of time, but avoiding them can have surprisingly quick benefits.

Cosmetics and personal care products contain many EDCs, particularly dioxins, the paraben (PB) and benzophenone (BP) families, and many of the most common EDCs mimic estrogens and increase oxidative stress.

EDCs also disrupt the normal development of follicles and the function of the hypothalamus-pituitary-ovarian axis (HPO), which causes changes to the structure of ovaries and the uterus and an increased risk of retrograde menstruation. ⁱⁱ

Oxidative Stress

Oxidative stress (OS) occurs when there’s an imbalance between the production of “free radicals” and the body’s antioxidant defence. This can be caused by either excessive “free radicals” (a feature of inflammation) or a lack of antioxidant protection.

There’s growing evidence that oxidative stress plays a significant role in the development and progression of endometriosis. ⁱⁱⁱ Low antioxidant levels (including Vitamin D3 and minerals) encourage endometriosis growth, and high oxidative stress levels raise the risk of developing endometriosis.

Antioxidant levels are closely related to diet, which, along with herbs, significantly impacts endometriosis growth and inhibition. Supplementing with antioxidants helps reverse the OS damage

caused to the testis and sperm by the potent hormone disruptor BPA (it’s much easier to measure these factors in male fertility). ^iv

Body Fat

Studies into body types and endometriosis have found that the women most at risk of endometriosis:  ^v

• Were lean as children
• Were lean in their teens
• Are relatively tall as adults, especially when sitting

The body shape of adults isn’t an indicator of risk, but the amount of body fat as children was. Adult leg length is linked to childhood BMI, as the earlier a girl starts her periods the less time her femur has to grow.

Age

The traditional view was endometriosis is progressive and that Stage I would become Stage IV at some point. However, this doesn’t appear to be the case, and changes in the opposite direction can naturally occur as women get older. What has also been recognised is that young women can have severe endometriosis, and a recent study found age has no bearing on the severity of the disease: ^vi

• Stage I and II are “equally likely to be present in women of all ages”
• Stage III and IV disease is “not age-dependent”
• (Stage I and II are considered mild, III is moderate, and Stage IV is severe)

This is important as disabling abdominal pain is often dismissed as “normal” for teenage girls, and a diagnosis is typically delayed for about five years from the onset of symptoms. In many cases, the opportunity to identify a life-changing condition is overlooked and making a diagnosis is also difficult. ^vii

The signs and symptoms of endometriosis in adolescents often differ from those typically found in adults because in adolescents:

• The menstrual pain may not be recognisable as part of the menstrual cycle (i.e. the pain occurs throughout the cycle)
• The pain may be unresponsive to commonly used medications (especially NSAIDs)
• The images typically seen in adult endometriosis, such as ovarian endometriotic cysts and fibrotic scars, are less common in adolescents
• Peritoneal lesions (which are less obvious and characteristic of early-stage endometriosis) are commonly found in adolescents

Diet

There’s a section devoted to diet and endometriosis, and these broad dietary factors significantly affect the chances of developing the disease and the severity of the condition: