Stroke Risk May Be Increased By Endometriosis, Study Finds

Endometriosis is a chronic disorder in which uterine lining tissue grows on other organs.

The disease, which occurs in women of childbearing age, is painful and can cause fertility problems – and it has typically been regarded as solely a reproductive health issue. New research highlights the need to understand how endometriosis may affect other body parts as well.

According to a recent study, women with endometriosis may be at a higher risk of having a stroke.

The takeaway message from this study is that endometriosis is an important issue that shouldn’t just be thought of as symptoms, such as fertility issues or debilitating pelvic pain, says Stacey A. Missmer, an associate professor of obstetrics, gynecology, and reproductive biology at Michigan State University. But also, a whole-body focus on women’s well-being.

According to Dr. Missmer, women with endometriosis should have a complete assessment of their health as well as their cardiovascular health.

Stacey A. Missmer used data from the Nurses’ Health Study II, which followed female nurses for 28 years between 1989 and 2017. All the participants of the study were between the ages of 25 and 42, and the majority were white. In nearly three decades, researchers recorded numerous instances of various conditions, including strokes.

The researchers took their data from more than 5,200 women from the Nurses’ Health Study II who had endometriosis and over 107,000 who did not have the condition. In the study, researchers discovered that women with endometriosis were about one-third (34 percent) more likely to suffer a stroke than those who did not. Those who underwent a hysterectomy (in which the uterus is removed) or oophorectomy (in which one or both ovaries are removed) were at 40% higher risk of stroke compared to women who did not have endometriosis. The team also found that no other risk factors, such as being older, going through menopause, or being overweight, were statistically significant.

In the view of Olga Bougie, MD, MPH, an assistant professor at Queens University in Kingston, Ontario, whose area of expertise is minimally invasive gynecologic surgery, stroke risks remain low.

it is true that that number can sound scary, but it does not mean that people with endometriosis will have a 34 percent chance of having a stroke. It’s much less than that, says Dr. Bougie, who was not involved in the study.

About one in five women between the ages of 55 and 75 will have a stroke, regardless of whether they have endometriosis. (They also don’t collect data on those assigned female at birth who don’t identify as women.) Only about 1 in 7 strokes occur in people aged 15 to 49, and that figure has been increasing in recent years.

Healthcare providers have long recognized that people at risk for stroke have high blood pressure, obesity, smoking, and diabetes. And now, physicians are beginning to better understand the connections between endometriosis and heart disease.

There was a small Polish study of endometriosis that appeared in Kardiologia Polska in 2020 and it included 44 women who had the condition and 76 women who did not. Those who have endometriosis were found to have thicker artery walls, which can increase the risk of heart disease.

The English study, published in BJOG: An International Journal of Obstetrics and Gynaecology in 2021, included more than 50,000 women with endometriosis and nearly 224,000 without the condition. Compared to women without endometriosis, those with the condition were about 25% more likely to have cardiovascular disease. They were approximately 20% more likely to have cerebrovascular disease, which includes strokes.

The growing body of research on the subject is still in its infancy, and according to Bougie, everyone should be aware of the signs and symptoms of stroke, even if they don’t have endometriosis.

It is too early for us to be telling people with endometriosis to go in for extra screening – we need to broaden our research beyond the Nurses’ Health Study, and study more racially diverse populations with different socioeconomic backgrounds, says Bougie.

Hysterectomy and stroke also seem to be associated, but the reasons are not yet clear, she says.
As Missmer points out, the primary care physicians who treat people with endometriosis should be aware that cardiologist may be required to be part of the patient’s care team.

They need to focus on good physical health, she says.

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