Endometriosis linked to higher stroke risk

Women with a history of endometriosis may be more likely to have a stroke later in life than their peers with no history of the chronic inflammatory condition, new research finds.

The study, published Thursday in the American Heart Association journal Stroke, suggested the higher risk may be due at least in part to procedures to treat the condition, such as having a hysterectomy, removing a woman's ovaries or postmenopausal hormone therapy.

Health care professionals should advise women who have been diagnosed with endometriosis to take preventive measures to mitigate the added cardiovascular risk, senior study author Stacey A. Missmer said in a news release.

"These results do not indicate that women who have endometriosis will have a stroke. Instead, these findings signify only an association of moderate relative risk. The absolute risk of stroke in women is low," said Missmer, a professor of obstetrics, gynecology and reproductive biology at Michigan State University College of Human Medicine in Grand Rapids. "Women with endometriosis should pay attention to their whole body and discuss added risks and preventive options with their health care team."

Endometriosis is an often painful condition that occurs when tissue similar to that lining the uterus grows outside of it. It may affect about 1 in 10 U.S. women of childbearing age. Research has linked endometriosis to a higher risk for other cardiovascular conditions, including heart attacks, high blood pressure and high cholesterol.

This study analyzed the relationship between endometriosis and two types of stroke: ischemic, caused by blood clots disrupting blood flow to the brain, and hemorrhagic, caused by bleeding in the brain. Researchers analyzed medical data for 112,056 women of childbearing age enrolled in the Nurses' Health Study from 1989 to 2017.

During the 28 years of follow-up, those who developed endometriosis were 34% more likely to have strokes than those who did not have the gynecological condition. Having a hysterectomy (having the uterus removed) or oophorectomy (having the ovaries removed) accounted for 39% of the higher stroke risk, while postmenopausal hormone therapy accounted for 16% of the increased risk.

"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 research, she said, suggests hysterectomy is associated with elevated stroke risk even without a history of endometriosis.

But other risk factors shouldn't be overlooked, Missmer said. "Clinicians should look at the health of the whole woman, 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."

Dr. Garima Sharma, director of cardio-obstetrics at Johns Hopkins Cardiology in Baltimore, said in the news release that the higher stroke risk associated with endometriosis was an important finding for "both patients and clinicians." She was not involved in the research.

"Most importantly, this study underscores the importance of understanding reproductive and gynecological history," Sharma said.

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