Endometriosis Linked to 46% Higher Type 2 Diabetes Risk

Women diagnosed with endometriosis face a significantly higher risk of developing type 2 diabetes (T2D) than women without endometriosis, according to a new retrospective cohort study in Diabetologia. The research drew on the ARCHES study built from the Utah Population Database. The analysis followed nearly 3 million individuals assigned female at birth for a mean of 10.8 years, including roughly 100,000 women with a diagnosed endometriosis.¹

The study used a dynamic, population-based retrospective cohort drawn from the Utah Population Database spanning 1996 to 2021. Of the 2,939,364 women in the cohort, 99,978 had an endometriosis diagnosis identified through International Classification of Diseases (ICD), Ninth Revision and Tenth Revision codes. The investigators used Cox proportional hazards models on a calendar time scale, adjusting for birth year, birth state, race/ethnicity, age, and baseline body mass index (BMI). The authors note that no prior studies had examined T2D risk while accounting for both endometriosis subtype and gestational diabetes history simultaneously.

Endometriosis Subtypes Diabetes Risk

Overall, women with endometriosis had a 46% higher risk of developing T2D than women without the diagnosis (adjusted HR [aHR] 1.46; 95% CI, 1.43-1.50). That risk diverged sharply by subtype. “Other site” endometriosis, specified, carried the highest risk (aHR 2.67; 95% CI, 2.51–2.84), followed by “other site,” unspecified (aHR 2.47; 95% CI, 2.35-2.60), superficial peritoneal disease (aHR 1.67; 95% CI, 1.61-1.74), ovarian endometriosis (aHR 1.61; 95% CI, 1.53-1.69), deep infiltrating endometriosis (aHR 1.45; 95% CI, 1.24-1.69), and adenomyosis (aHR 1.34; 95% CI, 1.30-1.38). Notably, the authors point out that the “other site” categories carrying the steepest risk estimates are also the least anatomically specific and most prone to coding variability, meaning the largest numbers in the dataset are also the least precise.

Premenopausal women with endometriosis had a substantially higher risk than postmenopausal women (aHR 1.55 vs. 1.07, P < 0.001). Risk was also larger in women without obesity than in those with it (aHR 2.39 for BMI under 30 vs aHR 1.74 for BMI 30 or above), the inverse of what’s typically assumed about diabetes risk. A history of gestational diabetes didn’t explain the pattern either, as risk remained elevated whether women had prior gestational diabetes (aHR 1.99 without, aHR 2.05 with). The authors note that endometriosis is “a hormonally responsive condition that is characterized by heightened inflammatory and proliferative activity during the reproductive years,” and among lean women, “endometriosis-related inflammation may represent a larger contributor to metabolic dysfunction” than it does in women already carrying other metabolic risk factors.

Study Limitations: Endometriosis Linked to Type 2 Diabetes

Diagnoses relied on ICD codes rather than surgical confirmation, and sensitivity was lower for deep infiltrating endometriosis. Women with endometriosis also interact with the health system more frequently, raising the possibility that some of the association reflects surveillance bias rather than true excess risk. The study didn’t measure diet, physical activity, or hormonal treatment, though the authors ran an E-value analysis showing an unmeasured confounder would need at least a 2.28-fold association with both endometriosis and diabetes to fully explain the results. A sensitivity analysis restricted to laparoscopy-confirmed cases lowered the risk estimate.

The authors frame their findings as support for treating endometriosis as a marker warranting T2D screening, specifically in premenopausal women and those without obesity, who wouldn't otherwise be flagged as high-risk. They caution that the results should be interpreted carefully given the potential for residual confounding and detection bias, but argue the pattern nonetheless supports more targeted, personalized diabetes screening in women with endometriosis.

"Our findings add to a growing understanding that endometriosis may affect more than reproductive health alone," Maggie Fuzak Nunziato, a PhD candidate and lead author of the study, said in a statement from George Mason University's College of Public Health.²

References

1. Nunziato MF, Yan B, Schliep KC, et al. Endometriosis subtypes and risk of type 2 diabetes: the Advancing Research on Cardiovascular Health and Endometriosis Study (ARCHES) retrospective cohort study. Diabetologia. Published August 6, 2026. doi:10.1007/s00125-026-06828-w
2. Pearce K. Women with endometriosis face 46% higher risk of type 2 diabetes, study finds. George Mason University College of Public Health. Published August 10, 2026. Accessed September 11, 2026. https://publichealth.gmu.edu/news/2026-08/women-endometriosis-face-46-higher-risk-type-2-diabetes-study-finds