50% heritability; 7× risk with first-degree relative
Endometriosis has approximately 50% heritability, and women with a first-degree relative with the disease have about 7 times the normal risk.
Snapshot · The Peter Attia Drive
#397 ‒ Endometriosis and adenomyosis: diagnosis, fertility, reproductive aging, and emerging treatments | Renato Tomioka, M.D., Ph.D.
Explore episode
Jun 22, 2026
Where this was said
Endometriosis: definition, prevalence, infertility risk, and theories of disease development
At 6:21 · chapter starts 0:11
To understand endometriosis, Tomioka begins with the architecture of the uterus: the outer serosa, the muscular myometrium, and the inner endometrium where embryos implant. Endometriosis, he explains, is a chronic disease in which tissue resembling the endometrium migrates outside the uterus — onto the ovaries, fallopian tubes, bladder, bowel, appendix, and even the diaphragm. The scale is striking: approximately 10% of reproductive-aged women, 200 million globally. [1] — Renato Tomioka "10% of reproductive-age women: Endometriosis affects approximately 10% of reproductive-aged women, equating to roughly 200 million women gl…" 03:48 Among infertile women, 30 to 50% have endometriosis, and the relationship is causal — if a woman has endometriosis, she faces roughly a 40% chance of infertility. [2] — Renato Tomioka "30–50% infertility in endometriosis: Among women struggling with infertility, 30 to 50% have endometriosis, and if a woman has endometriosi…" 04:30 Tomioka notes the strong genetic signal: approximately 50% heritability and a sevenfold elevated risk for women with an affected first-degree relative. The mechanism he considers most important is retrograde menstruation — menstrual blood flowing backward through the fallopian tubes into the pelvis — which occurs in roughly 90% of all women, yet only 10% develop endometriosis, implicating immune dysregulation (particularly macrophage dysfunction) as the difference-maker.
10% of reproductive-age women
Endometriosis affects approximately 10% of reproductive-aged women, equating to roughly 200 million women globally.
30–50% infertility in endometriosis
Among women struggling with infertility, 30 to 50% have endometriosis, and if a woman has endometriosis, she faces roughly a 40% chance of being infertile.
90% of women have retrograde menstruation
Approximately 90% of women experience retrograde menstruation — menstrual flow traveling backwards through the fallopian tubes — yet only about 10% develop endometriosis.
Why Modern Women Have 4x the Lifetime Ovulatory Cycles as Their Ancestors
Two hundred years ago women had roughly 100 lifetime ovulatory cycles; today the number is closer to 400. Later menarche, earlier menarche now, fewer pregnancies, less breastfeeding — the modern reproductive pattern was never anticipated by evolution, and endometriosis prevalence is rising as a result.
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