Endometriosis may increase stroke risk in women
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Women with a history of endometriosis had elevated risk for stroke compared with women without a history of endometriosis, with a greater risk for women who underwent hysterectomy or oophorectomy, researchers reported.
Evidence suggests people with endometriosis may be at greater risk for CVD later in life and endometriosis may influence risk for cardiometabolic diseases, including stroke, through alterations in the endogenous inflammatory, immunologic and hormonal milieu, according to Stacey A. Missmer, ScD, professor of obstetrics, gynecology and reproductive biology at Michigan State University and adjunct professor of epidemiology at Harvard T.H. Chan School of Public Health.
Awareness of endometriosis
“The take-home message is people with endometriosis must think about their overall health and what symptoms may be emerging, and primary care physicians need to be aware of the endometriosis status of their patients,” Missmer told Healio. “There are other symptoms that accompany endometriosis, even in this cardiovascular and cerebrovascular realm. PCPs and primary care gynecologists must pay attention to things like hypertension and hypercholesterolemia in people with endometriosis.”
Missmer and colleagues analyzed data from adults participating in the Nurses’ Health Study II, an ongoing prospective cohort study initiated in 1989 across 14 states. Participants completed mailed questionnaires every 2 years on a variety of chronic diseases and risk factors; those with a history of stroke or endometriosis that was not confirmed by laparoscopy at baseline were excluded. Researchers followed participants through 2017 for development of incident ischemic and hemorrhagic stroke.
The findings were published in Stroke.
During 2,770,152 person-years of follow-up, researchers documented 893 incident cases of stroke.
In models adjusted for alcohol intake, BMI at age 18 years, current BMI, age at menarche, menstrual cycle pattern in adolescence, current menstrual cycle pattern, parity, oral contraceptive use history, smoking history, diet quality and physical activity, participants with laparoscopically confirmed endometriosis had a 34% greater risk for stroke compared with those without endometriosis (adjusted HR = 1.34; 95% CI, 1.1-1.62). Of the total association of endometriosis with risk for stroke, 39% of the risk was attributed to hysterectomy or oophorectomy (95% CI, 14-71) and 16% of the risk was attributed to hormone therapy (95% CI, 5-40).
There were no between-group differences in analyses stratified by age (younger or older than 50 years), infertility history, BMI or menopausal status.
‘Impacts beyond reproductive health’
“We want to make sure it is clear that this is not a huge increased risk; the absolute risk for stroke for any individual is still very small,” Missmer told Healio. “We do not want this to create panic or frighten women. However, these data reinforce for us that, in general, endometriosis is not just a gynecologic condition. Pelvic pain is important and undervalued, but there are impacts beyond reproductive health. This impacts whole women’s health across their entire life course.”
There are several different pathways through which endometriosis may be associated with risk for stroke, including chronic, long-term inflammation that accompanies the condition, according to Leslie V. Farland, ScD, assistant professor of epidemiology and biostatistics at the University of Arizona.
“This research shows that we must research the whole-body health of people with endometriosis to better understand how this condition, defined by a gynecologic reality, is impacting all these other aspects of their lives,” Farland told Healio.
For more information:
Stacey A. Missmer, ScD, can be reached at missmers@msu.edu.
Leslie V. Farland, ScD, can be reached at lfarland@arizona.edu.
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