Body fat percentage associated with endometriosis severity in cross-sectional analysis

Those with higher body fat percentage had lower odds of severe endometriosis, according to an Indonesian cross-sectional study published February 17, 2026, in International Journal of Women’s Health. The findings suggested an inverse relationship between adiposity measures and disease stage using the 2021 American Association of Gynecologic Laparoscopists (AAGL) Endometriosis Classification.

Endometriosis, characterized by the presence of endometrial glands and stroma outside the uterus, affects an estimated 10% of reproductive-age women worldwide, or approximately 190 million individuals. The condition has been associated with pelvic pain, infertility, and reduced quality of life. Although hormonal therapy and surgery are standard treatment approaches, the underlying mechanisms and modifiable risk factors remain incompletely understood.

Previous research examining the relationship between adiposity and endometriosis has yielded mixed findings. Several studies have reported an inverse correlation between body mass index (BMI) and endometriosis, suggesting that women with the condition are more likely to be underweight or have lower BMI compared with controls. Other investigations, however, have found no significant association between BMI or body fat percentage (BFP) and endometriosis. Additional anthropometric measures, including waist-to-hip ratio (WHR) and mid-upper arm circumference (MUAC), have also been explored, with varying results.

To clarify the relationship between adiposity and disease severity, investigators conducted a cross-sectional analytic study at Hasan Sadikin Hospital from July to October 2025. The study included women aged 20–45 years with endometriosis who were scheduled to undergo laparoscopic surgery. Women with suspected malignancy were excluded. Statistical analyses evaluated the associations between baseline characteristics, BMI, WHR, MUAC, and BFP with endometriosis stage, categorized as mild–moderate (Stage I–II) or severe (Stage III–IV) according to the AAGL 2021 classification.

Baseline characteristics did not differ significantly between the mild–moderate and severe groups. However, several anthropometric measures demonstrated significant associations with endometriosis stage. WHR was significantly associated with disease stage (P = 0.012), as were MUAC (P < 0.001) and BMI (P = 0.023).

The study also found a significant association between BFP and AAGL stage (P < 0.001). Higher BFP was inversely associated with more advanced endometriosis. Similarly, WHR and MUAC demonstrated significant negative associations with BFP in relation to disease stage for WHR ≤ 0.80, WHR > 0.80, and MUAC ≤ 23 cm. However, the association was not significant for MUAC > 23 cm.

In addition to adiposity measures, the authors reported that shorter menstrual cycles associated with higher BFP were linked to an increased risk of endometriosis.

Overall, the findings supported an inverse relationship between body fat percentage and endometriosis severity. Similar inverse patterns were observed for BMI, WHR, and MUAC. The authors concluded that adiposity measures may be associated with the severity of endometriosis, though the cross-sectional design limited conclusions about causality.

Reference:

Milla H, Ritonga MA, Bayuaji H, Heriyanto A, Direza FH. Association Between Body Fat Percentage and Endometriosis Severity Based on American Association of Gynecologic Laparoscopists 2021 Endometriosis Classification. Int J Womens Health. 2026. https://doi.org/10.2147/IJWH.S582542