Endometriosis may increase risk of stroke, study finds

About 1 in 10 women have endometriosis, a chronic condition in which tissue from the lining of the womb grows outside the uterus on other organs.

Endometriosis, which occurs in women of childbearing age, is often painful and can cause fertility problems – and it has long been considered purely a reproductive health issue. But a new study highlights the importance of understanding how endometriosis can affect other parts of the body.

According to a study published in Stroke on July 21, women with endometriosis may be at higher risk of having a stroke.

“The take-home message is that, while important, endometriosis is not just about symptoms such as fertility issues or debilitating pelvic pain, but also about a whole-body focus on a woman’s well-being” , declares Stacey A. Missmerdoctor of science in epidemiology and professor of obstetrics, gynecology and reproductive biology at Michigan State University, co-author of the study.

People with endometriosis need to think about the health of their whole body and especially their cardiovascular health, says Dr. Missmer.

The study authors used data from Nurses’ Health Study II, which included nurses followed for 28 years, from 1989 to 2017. All participants started the study when they were between the ages of 25 and 42, and the majority were Caucasian. Over nearly three decades, researchers have recorded incidents of different conditions, including strokes.

For the study, the researchers included more than 5,200 women from the Nurses’ Health Study II who had endometriosis and nearly 107,000 who did not. They found that people with endometriosis were about a third (34%) more likely to have a stroke, compared to those without. For women who had had a hysterectomy (when the uterus is removed) or oophorectomy (in which one or both ovaries are removed), the risk of stroke was about 40% higher than for women without. endometriosis. The team also found that there were no significant differences when patients had other risk factors, such as being older, going through menopause or being overweight.

According Olga Candle, MD, MPHassistant professor at Queens University in Kingston, Ontario, who specializes in minimally invasive gynecological surgery, it is important to understand that the relative risk of stroke is still low.

“That number may sound very scary, but it doesn’t mean that people with endometriosis have a 34% chance of having a stroke. The number is much smaller,” says Dr Bougie, who has no not participated in the study.

According to Centers for Disaster Control and Prevention (CDC), about 1 in 5 women between the ages of 55 and 75 will have a stroke, regardless of their endometriosis status. (The CDC does not yet collect data on people who were assigned female at birth and who do not live as female.) Only about 1 in 7 strokes occurs in people between the ages of 15 and 49, the CDC saysbut that number has increased over the past decade.

Health care providers have long recognized risk factors for stroke such as high blood pressure, obesity, smoking and diabetes. Today, researchers are beginning to better understand the links between endometriosis and cardiovascular disease in general.

A little polish study published in Cardiology Poland (Polish Journal of the Heart) in 2020, included 44 women with endometriosis and 76 age-matched women who did not have the condition. They found that people with endometriosis had thicker arterial walls, which forces the heart to work harder to pump blood and is a risk factor for heart disease.

A much taller Briton study published in BJOG: an international journal of obstetrics and gynecology in 2021 included more than 50,000 women with endometriosis and nearly 224,000 without the condition. The researchers found that, compared to women without endometriosis, those with the disease were about 25% more likely to have cardiovascular disease. They were just under 20% more likely to have cerebrovascular disease, which includes stroke.

The growing body of research on the subject is still new, and according to Bougie, everyone should be aware of the signs and symptoms of a stroke, whether or not they have endometriosis.

“It is too early for us to suggest that people with endometriosis benefit from additional screening – we need to look at populations other than the Nurses’ Health Study to see if we are seeing this in other populations as well. “says Bougie, noting that future studies will need to look at more racially diverse populations from different socioeconomic backgrounds.

There also appears to be an association between hysterectomy and stroke, but it’s still unclear exactly why, she says.

According to Missmer, primary care physicians caring for people with endometriosis should be aware that experts such as cardiologists may need to be involved in the patient’s care team.

“They need to focus on whole-body health,” she says.

About Geraldine Higgins

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