There’s a well-established link between celiac disease and reproductive disorders, but a new study presented at the recent American College of Gastroenterology (ACG) meeting is shedding light on just how deeply celiac disease can impact a woman’s reproductive system.

The new research—conducted by researchers at the Cleveland Clinic—suggests that women with celiac disease have a six times higher risk for ovarian dysfunction, three times higher risk of polycystic ovary syndrome, and a two times higher risk of developing endometriosis than women without celiac disease.

The researchers also found that celiac disease is linked with other reproductive conditions that affect women including infertility, pregnancy loss, and delayed menarche.

For the study, the research team pulled data on 9,368 women with celiac disease from the TriNetX database, which includes health records from 80 healthcare organizations in the United States. These women with celiac disease were compared to healthy controls.

On why this study is important, lead researcher Dr. Rama Nanah said in an interview with Healio, “By raising awareness of these higher rates of women’s health disorders in women with celiac disease, we hope this will provide a call to gastroenterologists to think of this association and evaluate patients accordingly, including referral to and partnership with our OB/GYN colleagues to care for these women. Early diagnosis and management are crucial for these patients to minimize complications and take advantage of their fertile lifespan should they be interested in a family.”