ObjectiveTo investigate whether an early need of hormonal contraceptive (HC), or a failure to find a suitable method, are warning signs for endometriosis.DesignA retrospective cohort study.SettingSweden.PopulationThe cohort consisted of 720 805 women aged 12–27 years during the period 2005–2017. All women, regardless of whether they received a diagnosis of endometriosis or not (reference group), were included.MethodsWe used data from Swedish national registers. Risks are expressed as crude and adjusted hazard ratios (HRs and aHRs, respectively) with 95% confidence intervals (95% CIs), adjusted for age, education level, civil status, parity, country of birth, and diagnoses of infertility, dysmenorrhea or depression.Main outcome measuresA diagnosis of endometriosis between 12 and 27 years of age.ResultsDuring this period, 3268 women were diagnosed with endometriosis (0.45%). Women who started HC at the ages of 12–14 years had a higher risk of receiving the diagnosis (aHR 2.53, 95% CI 2.21–2.90) than those who began at age 17 years or older. Having tried more types of HCs was associated with a twofold increased risk of endometriosis (more that three types of HC, aHR 2.31, 95% CI 1.71–3.12). Using HC for more than 1 year was associated with a decreased risk of endometriosis (>1 year, aHR 0.53, 95% CI 0.48–0.59). Women with endometriosis more commonly had dysmenorrhea, depression or infertility.ConclusionsThe use of HCs at an early age and a failure to find a suitable HC were identified as warning signs of later receiving an endometriosis diagnosis. A longer duration of HC usage reduced the risk of receiving the diagnosis.

中文翻译：

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子宫内膜异位症风险与激素避孕药的使用：一项全国性队列研究

目的调查早期需要激素避孕药 (HC) 或未能找到合适的方法是否是子宫内膜异位症的警告信号。设计一项回顾性队列研究。设置瑞典。人口该队列由同期 720 805 名 12-27 岁的女性组成2005 年至 2017 年。所有女性，无论是否被诊断为子宫内膜异位症（参考组），都被纳入其中。方法我们使用来自瑞典国家登记册的数据。风险以粗略风险比和调整后风险比（分别为 HR 和 aHR）表示，置信区间为 95%（95% CI），并根据年龄、教育水平、公民身份、胎次、出生国以及不孕症、痛经或不孕症的诊断进行调整。抑郁症。主要结局指标12至27岁之间诊断出子宫内膜异位症。结果在此期间，3268名女性被诊断患有子宫内膜异位症（0.45%）。与 17 岁或以上开始 HC 的女性相比，在 12-14 岁开始 HC 的女性获得诊断的风险更高（aHR 2.53，95% CI 2.21-2.90）。尝试更多类型的 HC 与子宫内膜异位症风险增加一倍相关（超过三种类型的 HC，aHR 2.31，95% CI 1.71-3.12）。使用 HC 超过 1 年与子宫内膜异位症风险降低相关（> 1 年，aHR 0.53，95% CI 0.48–0.59）。患有子宫内膜异位症的女性更常见有痛经、抑郁或不孕。 结论 早期使用 HC 和未能找到合适的 HC 被认为是后来接受子宫内膜异位症诊断的警告信号。 HC 使用时间越长，接受诊断的风险就越低。