Endometriosis linked to higher cardiovascular disease risk

By Dr. Liji Thomas, MDReviewed by Benedette Cuffari, M.Sc.Jan 27 2025

Systemic inflammation and high estrogen levels may be contributing to increased risks of heart disease and hypertension.

Study: Endometriosis and risk of cardiovascular disease: a systematic review and meta-analysis. Image Credit: Shutterstock AI / Shutterstock.com

A recent study published in BMC Public Health explores the association between endometriosis and cardiovascular risk.

What is endometriosis?

Endometriosis is characterized by the abnormal growth of endometrium-like tissue outside of the uterus, with pelvic organs like the ovaries, fallopian tubes, uterus, bladder, and intestines most frequently affected. Since these tissues act like the endometrium, which is the tissue that lines the uterus, they similarly thicken, break down, and bleed with each menstrual cycle; therefore, the periodic bleeding of endometriosis growths in organs outside of the uterus can lead to a wide range of symptoms, some of which include local inflammation, pelvic pain, congestive dysmenorrhea, excessive menstrual bleeding, and pain during intercourse.

Current estimates indicate that about 176 million women throughout the world are living with endometriosis, which reflects 5-10% of women of reproductive age affected by this condition. In the United States, about 11% of women are currently diagnosed with endometriosis, most of whom are between 30 and 40 years of age. Furthermore, 47% of women struggling with infertility are also living with endometriosis.

In addition to the debilitating symptoms caused by endometriosis, the presence of this condition also increases the risk of several chronic diseases including hypertension, atherosclerosis, coronary heart disease (CHD), dyslipidemia, autoimmune disease, and gynecological cancers.

Endometriosis and CVD

Endometriosis is associated with chronic systemic inflammation, oxidative stress, and high lipid levels, all of which contribute to atherosclerosis. Coronary artery atherosclerosis formation and progression increase the risk of cardiovascular diseases (CVDs) such as coronary artery disease (CAD), hypertension, high cholesterol, and diabetes; therefore, endometriosis may be implicated in the development of CVDs.

Previous studies have confirmed that endometriosis patients are at an increased relative risk (RR) of developing hypertension, hypercholesterolemia, ischemic heart disease (IHD), and myocardial infarction (MI) by 14%, 25%, 40%, and 52%, respectively. Despite these observations, the positive association between endometriosis and CVDs remain unclear, which has prevented healthcare providers from adequately managing patients with endometriosis who may be at a greater risk of these diseases.

To address these uncertainties, the researchers of the current study performed a systematic review and meta-analysis on cohort and case-control studies published between January 2000 and April 2023. A total of six cohort studies met the inclusion criteria and were examined in the final analysis.

Study findings of CVD risk

The current review identified a 23% and 13% increased risk of CVD and hypertension, respectively, among women with endometriosis as compared to those without this condition. Importantly, these findings should be cautiously interpreted, as additional research is needed to confirm the observed associations and explore the underlying mechanisms that may be involved.

Several different biological mechanisms may be involved in the increased risk of CVDs and hypertension in endometriosis patients, some of which include chronic inflammation, oxidative stress, and the increased activity of estrogen. High estrogen levels may negatively impact various aspects of the cardiovascular system including altered endothelial function, increased arterial stiffness, and the production of atherosclerotic plaques, all of which also increase the risk of CVDs.

Certain lifestyle factors like a sedentary lifestyle, poor diet quality, drinking, and smoking are implicated in the development of both endometriosis and CVDs, thus suggesting common pathologies between these two conditions.

Genetic characteristics may also be implicated in the association between endometriosis and cardiovascular disease. For example, previous European studies have identified several independent genetic loci to be positively involved with endometriosis and the occurrence of CVDs.

Conclusions

The current study is the first meta-analysis that has been performed to explore the association between endometriosis with CVD. The review findings indicate that the presence of endometriosis increases the risk of developing both CVDs and hypertension.

These observations emphasize the importance of closely monitoring these high-risk patients and initiating preventive interventions in a timely manner. For example, clinicians can incorporate treatments that target chronic inflammation, oxidative stress, and hormonal pathways into their strategies for managing patients with endometriosis.

Recognition of endometriosis as a potential risk factor for CVD allows for early cardiovascular risk assessment and intervention, with a focus on lifestyle changes and personalized care to reduce cardiovascular risk in endometriosis patients.”