Gynecological conditions may raise risk of heart disease and stroke

Having one or more common gynecological disorders, such as endometriosis or heavy or irregular periods, may be linked to a heightened risk of heart disease and conditions that affect blood flow to the brain (cerebrovascular disease), finds a pooled data analysis of the available evidence published online in the journal Heart.

Although the quality of the studies included in the analysis was variable, the researchers nevertheless conclude that clinicians and the public need to be more aware of these associations to potentially mitigate the risks.

Long term non-cancerous gynecological disorders are common and include polycystic ovary syndrome (PCOS), endometriosis (where tissue similar to the womb lining grows outside of the womb), adenomyosis (where the womb lining grows into the muscular wall), uterine fibroids, primary dysmenorrhoea (painful menstrual cramps), chronic pelvic pain, irregular and/or very heavy periods, and abnormal uterine bleeding, explain the researchers. 

These disorders significantly affect women's health and wellbeing. And previously published research indicates that they may be associated with cardiovascular or cerebrovascular disease, they add.

To explore this further, the researchers scoured research databases looking for relevant studies published up to April 2024. From an initial haul of 59 studies, 28, involving 3,271,242 women, were eligible for systematic review and inclusion in the pooled data analysis.

Only endometriosis, polycystic ovary syndrome, heavy periods, and irregular menstrual cycles featured in the studies included in the analysis.

Overall, the pooled data analysis of the study results showed that compared with people without one of these conditions, those who had at least one had a significantly (28%) higher risk of cardiovascular and cerebrovascular disease.

Specifically, their risk of ischaemic heart disease was 41% higher, while their risk of cerebrovascular disease alone was 33% higher.

Further analysis indicated that the overall risk of cardiovascular and cerebrovascular disease and each of its components was higher among those with a history of endometriosis or polycystic ovary syndrome.

The researchers caution that the design and methodology of the included studies varied considerably, and over half (53.5%) of the studies were scored as having a very high risk of bias, largely because of the lack of adequate consideration of potentially influential factors. 

And several aspects of cardiovascular disease weren't covered by the included studies, such as atrial fibrillation (abnormal heart rhythm).

But the researchers nevertheless suggest that there may be plausible biological pathways linking cardiovascular and cerebrovascular disease and common gynecological disorders, including systemic inflammation and oestrogen production.

There may also be an overlap between gynecological risk factors and cardiovascular risk factors, they suggest, pointing out that metabolic syndrome is often present in people with polycystic ovary syndrome, for example.

"The association between [cardiovascular and cerebrovascular disease] and [common gynecological disorders] requires further exploration with high-quality longitudinal studies adjusted for confounders to establish temporal relationships and causality," they emphasise. 

But they nevertheless conclude: "Although the extent of this association is still to be explored, and causality has not been established, the findings suggest that it is important to raise awareness of the potential association…. both in the general public and healthcare professionals. 

"Awareness of this association would allow healthcare professionals to advise patients regarding risk-reducing behavioural changes and interventions, to potentially prevent or delay the onset of, or reduce the severity of [cardiovascular and cerebrovascular disease]."