Endometriosis & Heart Disease
Women with endometriosis, especially premenopausal women, may have a higher risk of heart disease; as a study showed that these women were three times more likely to have a heart attack, chest pain, or need treatment for blocked arteries compared to women without endometriosis. This information comes from research done at Brigham and Women’s Hospital (BWH).
What Did Researchers Learn about Endometriosis and Heart Disease?
During 20 years of follow-up of the study, researchers found that compared to women without endometriosis, women with the condition were:
52 percent increased risk of heart attack
91 percent increased risk of developing angina (chest pain)
35 percent increased risk of needing surgery or stenting to open blocked arteries.
Why?
INFLAMMATION
We know that endometriosis is associated with inflammation. This inflammation can contribute to heart disease, as testing for inflammatory markers in the heart (cardiac CRP) is a common way to test for heart disease risk. We know that this inflammatory response alters the cardiovascular system, especially in women with endometriosis. There are enhanced inflammatory responses which may inhibit vascular reactivity, and are associated with endometriosis development.
HORMONES
Women with endometriosis are commonly treated with hormonal interventions, often with the goal to suppress endometriotic lesions growth. Hormone-affecting interventions include the birth control pill and hysterectomies, both of which have cardiovascular impacts.
The birth control pill increases the risk of blood clots, this is common knowledge in the medical community. Estrogen in birth control pills, patches, implants, rings and injections can cause blood to clot easier, which can cause a heart attack if the clot blocks blood flow to the heart, or can cause a stroke if the clot blocks blood flow to the brain.
A Cochrane review study showed that women who take a higher dose combined oral contraceptive pill have a 60% increased risk of arterial thrombosis (blood clots) compared with women who did not use oral contraceptive pills. The risk was twice as high in women taking pills with higher doses of estrogen. Birth control pills do not cause heart disease. They do tend to increase a woman’s blood pressure. If a woman has other risk factors for heart disease, taking birth control pills can compound that risk.
The increased risk of heart disease seen in the women with endometriosis may also be due in part to the common surgical treatment for the condition: complete hysterectomy, including removal of the ovaries. This results in surgically induced menopause and a loss of estrogen, which is known to increase women’s risk of heart disease. However, this loss of estrogen only accounted for part of the increase in risk in the original Brigham and Women’s Hospital study, as endometriosis patients who did not have a hysterectomy still had a greater heart disease risk than women who did not have endometriosis.
What Can You Do If You Have (or Think You Have) Endometriosis?
First, listen to your body. If you are feeling chest pain or discomfort beyond what seems normal to you, then see your medical practitioner. Second, start adopting more heart-healthy lifestyle habits, be screened for heart disease, know your family risk for heart disease, and be familiar with symptoms, because heart disease remains the primary cause of death in women
DIET
Eat a heart healthy diet: high in vegetables, healthy fats, high in fiber, rich in healthy proteins (especially fish). Avoid sugar, processed carbs, low fiber grains, unhealthy fats (fried foods, trans fats, saturated fats), and excessive red meat (e.g. mediterranean diet or DASH diet).
STAY ACTIVE
It is clear that physical activity decreases risk of cardiovascular events. The American Heart Association recommends at least 30 minutes of moderate to rigorous physical activity per day.
MAINTAIN A HEALTHY WEIGHT & BLOOD SUGAR
Losing weight can decrease chronic inflammation, which is one of the key issues with both endometriosis and cardiovascular disease. Diabetes is also a risk factor for heart disease, maintaining optimal blood sugars will help with weight maintenance or loss, as well as decrease risk for heart disease.
QUIT OR DON'T START SMOKING
Smoking is the No. 1 individual risk factor for dying in America, according to a recent report from the Institute for Health Metrics and Evaluation at the University of Washington.
RECOGNIZE THE SYMPTOMS OF A HEART ATTACK
Heart disease and stroke cause 1 in 3 women’s deaths each year, according to the American Heart Association. Routine medical exams where your blood pressure and cholesterol are checked are all important for young women.
Here are some common heart attack symptoms in women:
Uncomfortable pressure, squeezing, fullness or pain in the center of your chest that lasts more than a few minutes, or goes away and comes back.
Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath with or without chest discomfort.
Breaking out in a cold sweat, nausea or lightheadedness.
Focusing on overall health and addressing inflammation and hormone imbalance is a mainstay in the treatment of endometriosis. Additionally addressing diet and lifestyle will help eliminate or reduce cardiovascular disease risk.
Sources:
Luca Santoro, Ferruccio D'Onofrio, Sebastiano Campo, Pietro Manuel Ferraro, Paolo Tondi, Vincenzo Campo, Andrea Flex, Antonio Gasbarrini, Angelo Santoliquido, Endothelial dysfunction but not increased carotid intima-media thickness in young European women with endometriosis, Human Reproduction, Volume 27, Issue 5, May 2012, Pages 1320–1326, https://doi.org/10.1093/humrep/des062
Hu, Xinli, et al. “Vascular Endothelial-Specific Dimethylarginine Dimethylaminohydrolase-1–Deficient Mice Reveal That Vascular Endothelium Plays an Important Role in Removing Asymmetric Dimethylarginine.” Circulation, vol. 120, no. 22, 2009, pp. 2222–2229., doi:10.1161/circulationaha.108.819912.
Roach RE.J., Helmerhorst FM, Lijfering WM., Stijnen T, Algra A, Dekkers OM. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.: CD011054. DOI: 10.1002/14651858.CD011054.pub2
Schenken, R., Barbieri, R. and Eckler, K. (2019). Endometriosis: Treatment of pelvic pain. [online] Uptodate.com. Available at: https://www.uptodate.com/contents/endometriosis-treatment-of-pelvic-pain [Accessed 18 Apr. 2019].
University of Colorado OB/GYN & Family Planning. (2019). Heart Disease & Birth Control | University of Colorado Ob/Gyn. [online] Available at: https://obgyn.coloradowomenshealth.com/health-info/birth-control/medical-conditions-birth-control/heart-disease [Accessed 1 Apr. 2019].
www.heart.org. (2015). Heart Attack Symptoms in Women. [online] Available at: https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women [Accessed 18 Apr. 2019].