Is there a link between heart disease and endometriosis?

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Estrogen has a protective effect on the heart, so low estrogen states induced by surgical menopause or long term estrogen suppression should be considered when considering treatment (Iorga et al., 2017). 

There is not much literature about endometriosis and heart disease. Marchandot et al. (2022) reports that there are some overlaps in contributors to both heart disease and endometriosis, such as “chronic inflammation, enhanced oxidative stress, endothelial dysfunction, and cellular proliferation.” Some research indicates “increased arterial stiffness and impaired flow-mediated dilation, a surrogate marker of endothelial dysfunction potentially reversible after surgical treatment, were associated with endometriosis” (Marchandot et al., 2022).

Some risk factors for heart disease have been found in those with endometriosis, including hypertension, dyslipidemia, and obesity. Research suggests that the link between hypertension and endometriosis may be because of certain treatments for endometriosis, namely from early hysterectomy/oophorectomy and from use of NSAIDs (Marchandot et al., 2022). In fact, “hysterectomy in women aged 50 years or younger has been associated with a significantly increased risk of ischaemic heart disease, with oophorectomy linked to an increased risk of both [coronary artery disease] and stroke” (Marchandot et al., 2022). Shuster et al. (2010) add that “regardless of the cause…women who experience premature menopause (before age 40 years) or early menopause (between ages 40 and 45 years) experience an increased risk of overall mortality, cardiovascular diseases, neurological diseases, psychiatric diseases, osteoporosis, and other sequelae.” High cholesterol has also been associated with endometriosis- a 25% increased risk in those with endometriosis (Marchandot et al., 2022). Marchandot et al. (2022) also reports that “the role of hormonal treatment strategies for endometriosis, including combined oral contraceptives, progestins, and gonadotrophin-releasing hormone (GnRH) analogues, has been highly questioned regarding a potentially enhanced lipid profile, cardiovascular risk profile, and weight gain.”

Marchandot et al. (2022) urge caution in interpreting results as “only small associations between endometriosis and CVD have been reported in the literature” and that current studies have been limited “by small sample sizes, observational designs, and the specific characteristics of the population from which the samples are derived (high-income countries, cohort study of hospital-based healthcare workers, primarily Caucasian Europeans, etc.).” They also state that endometriosis treatments influence cardiovascular risk factors (“the confounding influence of hormonal, non-hormonal, and pain-related interventions further complicate the cause-and-effect relationship in CV endpoints”) (Marchandot et al. 2022).

References

Marchandot, B., Curtiaud, A., Matsushita, K., Trimaille, A., Host, A., Faller, E., … & Morel, O. (2022). Endometriosis and cardiovascular disease. European Heart Journal Open2(1), oeac001. https://doi.org/10.1093/ehjopen/oeac001

Shuster, L. T., Rhodes, D. J., Gostout, B. S., Grossardt, B. R., & Rocca, W. A. (2010). Premature menopause or early menopause: long-term health consequences. Maturitas65(2), 161-166. doi: 10.1016/j.maturitas.2009.08.003

  • Mu, F., Rich-Edwards, J., Rimm, E. B., Spiegelman, D., & Missmer, S. A. (2016). Endometriosis and risk of coronary heart disease. Circulation: Cardiovascular Quality and Outcomes9(3), 257-264. Retrieved from http://circoutcomes.ahajournals.org/content/9/3/257 

“In this large, prospective cohort, laparoscopically confirmed endometriosis was associated with increased risk of CHD. The association was strongest among young women. Hysterectomy/oophorectomy was associated with higher risk of CHD and could partially explain the association between endometriosis and CHD.”

  • Iorga, A., Cunningham, C. M., Moazeni, S., Ruffenach, G., Umar, S., & Eghbali, M. (2017). The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy. Biology of sex differences8(1), 1-16.  Retrieved from https://bsd.biomedcentral.com/articles/10.1186/s13293-017-0152-8   

“The lower incidence of cardiovascular disease in women during reproductive age is attributed at least in part to estrogen (E2). E2 binds to the traditional E2 receptors (ERs), estrogen receptor alpha (ERα), and estrogen receptor beta (ERβ), as well as the more recently identified G-protein-coupled ER (GPR30), and can exert both genomic and non-genomic actions. This review summarizes the protective role of E2 and its receptors in the cardiovascular system and discusses its underlying mechanisms with an emphasis on oxidative stress, fibrosis, angiogenesis, and vascular function.”

See “Effects of Long Term Low Estrogen States”