Association of Sleep Traits, Physical Activity, and Sedentary Leisure Behavior With Female Reproductive Health: A Two-Sample Mendelian Randomization Analysis

Purpose

Living habits affect female endocrine function and fertility, along with aging and other life factors. Because of this, female reproductive health can be promoted through living habit adjustment.

Methods

We used two-sample Mendelian randomization analysis with summary datasets from a genome-wide association study to investigate the causal relationships between sleep traits, sedentary leisure behavior, physical activity, and reproductive health traits in women, calculating odds ratios (ORs) and 95% confidence intervals (CIs). Exposure genetic instruments were used for variants that were significantly related to traits. The inverse-variance weighted (IVW) method was used for the main analysis, and we also performed MR-Egger and weighted median analyses to supplement the sensitivity test. Horizontal pleiotropy was detected using the MRE intercept and MR-PRESSO methods, and heterogeneity was assessed using Cochran's Q statistics, IVW, and MR-Egger.

Results

Insomnia showed a significant inverse causal association with endometriosis [OR (95% CI) IVW = 1.80 (1.16, 2.80), P = 0.009] and abnormal menstruation [OR (95% CI) IVW = 2.37 (1.34, 4.20), P = 0.003]. Sleep duration was negatively related to menopause age (beta IVW = -0.034, P = 0.001), and long sleep duration could be a protective factor of endometriosis [OR (95% CI) IVW = 0.07 (0.01, 0.72), P = 0.024]. Strenuous sports were also negatively correlated with female infertility [OR (95% CI) IVW = 0.10 (0.02, 0.68), P = 0.019]. Sensitivity analysis revealed no signs of horizontal pleiotropy or heterogeneity.

Conclusion

Our findings suggest that insomnia is an adverse factor correlated with endometriosis and abnormal menstruation and that longer sleep duration protects against endometriosis. Adequate sleep and regular schedules may decrease the risk of endometriosis and abnormal menstruation, helping improve the reproductive health of women.

A systematic literature review on patient-reported outcome domains and measures in nonsurgical efficacy trials related to chronic pain associated with endometriosis: an urgent call to action

ABSTRACT

Endometriosis, a common cause for chronic pelvic pain, significantly affects quality of life, fertility, and overall productivity of those affected. Therapeutic options remain limited, and collating evidence on treatment efficacy is complicated. One reason could be the heterogeneity of assessed outcomes in nonsurgical clinical trials, impeding meaningful result comparisons. This systematic literature review examines outcome domains and patient-reported outcome measures (PROMs) used in clinical trials. Through comprehensive search of Embase, MEDLINE, and CENTRAL up until July 2022, we screened 1286 records, of which 191 were included in our analyses. Methodological quality (GRADE criteria), information about publication, patient population, and intervention were assessed, and domains as well as PROMs were extracted and analyzed. In accordance with IMMPACT domain framework, the domain pain was assessed in almost all studies (98.4%), followed by adverse events (73.8%). By contrast, assessment of physical functioning (29.8%), improvement and satisfaction (14.1%), and emotional functioning (6.8%) occurred less frequently. Studies of a better methodological quality tended to use more different domains. Nevertheless, combinations of more than 2 domains were rare, failing to comprehensively capture the bio-psycho-social aspects of endometriosis-associated pain. The PROMs used showed an even broader heterogeneity across all studies. Our findings underscore the large heterogeneity of assessed domains and PROMs in clinical pain-related endometriosis trials. This highlights the urgent need for a standardized approach to both, assessed domains and high-quality PROMs ideally realized through development and implementation of a core outcome set, encompassing the most pivotal domains and PROMs for both, stakeholders and patients.