Sinaii, N, Cleary, S D, Ballweg, M L et al. · Human reproduction (Oxford, England) · 2002 · DOI
This study found that women with endometriosis—a painful condition where tissue grows outside the uterus—have much higher rates of ME/CFS, fibromyalgia, and autoimmune diseases compared to the general population. Researchers surveyed nearly 3,700 women with endometriosis and compared their health conditions to published data about women without endometriosis. Women with endometriosis were 150 times more likely to have ME/CFS and nearly twice as likely to have fibromyalgia.
This study demonstrates a significant epidemiological association between endometriosis and ME/CFS, suggesting shared underlying immune dysregulation mechanisms. For ME/CFS patients and researchers, understanding the high co-occurrence of these conditions may provide clues about common pathophysiological pathways involving autoimmune activation, endothelial dysfunction, and immune dysregulation that warrant further investigation.
This study does not establish causation—it cannot determine whether endometriosis causes ME/CFS, whether ME/CFS causes endometriosis, or whether both conditions share a common underlying cause. The cross-sectional design and reliance on self-reported data and historical comparisons (rather than matched concurrent controls) limit causal inference. The study also does not prove that the elevated rates reflect true biological associations versus potential diagnostic bias or shared symptom reporting patterns.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Sinaii, N, Cleary, S D, Ballweg, M L, Nieman, L K, & Stratton, P (2002). High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis.. Human reproduction (Oxford, England). https://doi.org/10.1093/humrep/17.10.2715
BibTeX
@article{mecfsatlas-sinaii-2002-high-rates,
author = {Sinaii, N and Cleary, S D and Ballweg, M L and Nieman, L K and Stratton, P},
title = {High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis.},
journal = {Human reproduction (Oxford, England)},
year = {2002},
doi = {10.1093/humrep/17.10.2715},
note = {PubMed: 12351553},
url = {https://www.mecfsatlas.com/evidence/sinaii-2002-high-rates},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/sinaii-2002-high-rates
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