Marijuana, Cigarette Smoking, and Adenomyosis Risk

Abstract

The uterine condition adenomyosis can produce substantial symptoms, including painful menses and heavy menstrual bleeding. Although the etiology of adenomyosis remains enigmatic, estrogen plays a central role in disease development. Two common exposures that may alter estrogen concentrations and affect adenomyosis risk are marijuana and cigarette smoking.

We investigated these exposures in relation to adenomyosis using data from a novel case-control study of adenomyosis conducted among female enrollees ages 18-59 years of a large, integrated healthcare system in Washington State. Cases were women with incident, pathology-confirmed adenomyosis diagnosed by hysterectomy in years 2001-2006 (n=386). Given the potential for different results based on control group selection, two control groups were used: 1) randomly selected enrollees with intact uteri, age-matched to cases (″population controls″, n=323), and 2) hysterectomy controls (n=233). Data on marijuana and cigarette smoking were collected by in-person structured interviews; joint-years of marijuana smoking and pack-years of cigarette smoking were estimated. We conducted unconditional logistic regression to estimate the adjusted odds ratios (OR) and 95% confidence intervals (CI), comparing cases with hysterectomy controls and population controls separately. Using either control group, we observed no association between marijuana smoking and adenomyosis. However, smoking more than 15 pack-years (vs. never smoking) was associated with a 20% increased risk of adenomyosis in analyses using population controls (OR 1.2, 95% CI: 0.8-2.2) and a 60% increased risk of adenomyosis in analyses using hysterectomy controls (OR 1.6, 95% CI: 0.9-2.8). Our results suggest that cigarette smoking, but not marijuana smoking, increases adenomyosis risk.