EPIDEMIOLOGY a reduced threat. Circulating estradiol and estrone, which

reproductive influences has remained sedulously interrelated with likelihood
for endometriosis, suggesting that hormonal disparity may have a substantial
effect on the possibility of developing endometriosis. For Instance, early age
at menarche 10, 11, 12, 13, 14 and short menstrual cycle length 13,14 are
interconnected with an incremented threat, while parity 13 and current
utilization of oral contraceptives 15 are cognate with a reduced threat.
Circulating estradiol and estrone, which stimulate ectopic and eutopic
endometrial tissue, are more preponderant amongst women at an earlier age of
menarche and in nulliparous women 16-20. Though not a reproductive risk
factor, a reliable inverse connection has withal been witnessed amongst body
mass index (BMI) and endometriosis 10, 11–12, 14, 58, 59 and may additionally
relate to hormonal disparities between heftily ponderous women and tenuous
women. Haplessly, the evaluation of tubal ligation, parity, and oral
contraceptive use in cognation to endometriosis risk has been troubled by
methodologic issues. Tubal ligation has been hypothesized to drop endometriosis
possibility through obstructing retrograde menstruation from reaching the
pelvic cavity. Yet, the connection between tubal ligation and endometriosis is
arduous to decipher since endometriosis is illustrated by infertility, and
women who seek a tubal ligation are more liable to be parous than the overall
population 21, 22. The mean age at diagnosis is 25–29 years, but it is often
more preponderant in women who present with infertility rather than pelvic
pain. 23 Though the mechanism is undetermined, circulating estrogens are
known to be lesser in women who smoke 37 and could impede the magnification
and persistence of endometriotic tissue. The association between alcohol and
caffeine consumption is similarly commixed and may depend on fertility status