A new study published today in Stroke indicated that women with endometriosis may have a greater risk of stroke compared to women without chronic inflammatory disorder.

Authors of the study estimate that about 10% of reproductive-aged women in the United States have endometriosis, which is characterized by abnormal growth of endometrial-like tissue outside the uterus. Endometriosis has been linked to an increased risk of heart attack, stroke, high blood pressure, and high cholesterol in women.

According to the principal author of the study Stacey A. Missmer, Sc.D., these data show that women with a history of endometriosis may be at higher risk of stroke as well. 

“Clinicians should look at the health of the whole woman,” adds the study author, “including elevated blood pressure, high cholesterol and other new stroke risk factors, not only symptoms specifically associated with endometriosis, such as pelvic pain or infertility.”

This study, led by first author Leslie V. Farland, Sc.D., an assistant professor of epidemiology and biostatistics at the University of Arizona in Tucson, looked at the link between endometriosis and the development of ischemic or hemorrhagic stroke among women participating in the Nurses’ Health Study II.

At the beginning of the study in 1989, 112,056 female nurses from 14 different states in the United States participated in the analysis. These nurses ranged in age from 25 to 42 years old.

2017 marked the end of the current study. Endometriosis was diagnosed with laparoscopy, a surgical procedure in which a fiber-optic instrument is inserted through the abdominal wall to see the organs in the abdomen or to allow a surgical procedure.

5,244 women were reported to have endometriosis, and 93% of the participants, including those who had the condition, were white women.

For many potential confounders or risk factors, including alcohol consumption, current body mass index, adolescent menstrual cycle pattern, exposure to oral contraceptives and postmenopausal hormones, smoking history, diet, physical activity, aspirin use, race/ethnicity, and income, researchers analyzed data collected every two years.

Researchers also looked into the possibility of other mediating factors, such as high blood pressure, high cholesterol, hysterectomy (removal of the uterus), oophorectomy (removal of the ovaries), and postmenopausal hormone therapy, explaining the association between endometriosis and risk of stroke.

Researchers recorded 893 strokes throughout the course of the 28 years of follow-up, which included confirmations from medical records.

The research revealed:

• Stroke risk was 34% higher in women with endometriosis (5,244) than in women without the illness (106,812).
• Hysterectomy and/or oophorectomy (39 percent) and postmenopausal hormone therapy were found to be the most significant risk factors for stroke in women with endometriosis (16 percent).
• Endometriosis and stroke were found to have no significant differences based on age, history of infertility, body mass index, or whether or not a woman was menopausal.

“There are circumstances when a hysterectomy and/or oophorectomy is the best choice for a woman,” Missmer said. “However, we also need to make sure that patients are aware of the potential health risks associated with these procedures.” 

Other evidence indicates that having a hysterectomy increases the risk of stroke even in those who have never had endometriosis,” according to the authors.

These findings do not suggest that endometriosis-positive women will experience a stroke. Instead, these results only show a moderate relative risk relationship. Women have a low absolute risk of stroke, Missmer highlighted. 

“Women with endometriosis should pay attention to their whole body and discuss added risks and preventive options with their health care team.”

As the director of cardio-obstetrics and assistant director of medicine at Johns Hopkins Cardiology in Baltimore, Garima Sharma, M.B.B.S. said, “We know that adverse pregnancy outcomes are associated with increased risk of premature cardiovascular disease.” 

But “this study sheds light on the association of gynecological issues such as endometriosis with stroke, which could impact both patients and clinicians.”

The research had several limitations. There was no information on stroke subtypes. As a result, it was unable to assess how endometriosis and various stroke subtypes relate to one another.

Another drawback of the study is that it was impossible to assess the effects of the length of time since the development of endometriosis-related symptoms and the age at endometriosis diagnosis.

Image Credit: Getty

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