Article Text

Tobacco smoking and risk of endometriosis: a systematic review and meta-analysis
  1. Francesca Bravi1,
  2. Fabio Parazzini1,2,
  3. Sonia Cipriani1,2,
  4. Francesca Chiaffarino2,
  5. Elena Ricci2,
  6. Vito Chiantera3,
  7. Paola Viganò4,
  8. Carlo La Vecchia1
  1. 1Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
  2. 2Department of Obstetrics, Gynecology and Neonatology, IRCSS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
  3. 3Department of Gynecology, Charitè Universitätsmedizin, Berlin, Germany
  4. 4Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milan, Lombardia, Italy
  1. Correspondence to Dr Fabio Parazzini; Fabio.Parazzini{at}


Objective Since conflicting results have been published on the role of tobacco smoking on the risk of endometriosis, we provide an up-to-date summary quantification of this potential association.

Design We performed a PubMed/MEDLINE search of the relevant publications up to September 2014, considering studies on humans published in English. We searched the reference list of the identified papers to find other relevant publications. Case–control as well as cohort studies have been included reporting risk estimates on the association between tobacco smoking and endometriosis. 38 of the 1758 screened papers met the inclusion criteria. The selected studies included a total of 13 129 women diagnosed with endometriosis.

Setting Academic hospitals.

Main outcome measure Risk of endometriosis in tobacco smokers.

Results We obtained the summary estimates of the relative risk (RR) using the random effect model, and assessed the heterogeneity among studies using the χ2 test and quantified it using the I2 statistic. As compared to never-smokers, the summary RR were 0.96 (95% CI 0.86 to 1.08) for ever smokers, 0.95 (95% CI 0.81 to 1.11) for former smokers, 0.92 (95% CI 0.82 to 1.04) for current smokers, 0.87 (95% CI 0.70 to 1.07) for moderate smokers and 0.93 (95% CI 0.69 to 1.26) for heavy smokers.

Conclusions The present meta-analysis provided no evidence for an association between tobacco smoking and the risk of endometriosis. The results were consistent considering ever, former, current, moderate and heavy smokers, and across type of endometriosis and study design.


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