Endometriosis and the risk of coronary heart disease

Endometriosis is a gynaecological disease that affects many women. It is a painful disorder in which the endometrium, a tissue that usually lines the inside of the uterus, grows outside the uterus. This not only causes severe pelvic pain during periods but may also cause fertility problems and many women complain of an increase in pain over the years as well.

Endometriosis may also be associated with chronic systemic inflammation, heightened oxidative stress, and atherogenic lipid profile. These conditions often increase a women’s risk for coronary heart disease (CHD).

A research study, Endometriosis and the Risk of Coronary Heart Disease, published in Circulation: Cardiovascular Quality and Outcomes looked at data from the Nurses Health Study which followed over 116,000 women over 20 years. Nearly 12,000 participants had endometriosis — the growth of the tissue that lines the uterus to other places in the body. The study found out that the overall rate for heart disease was 21 cases per 100,000 women under 40; however, the researchers found that for every 100,000 women with endometriosis, the heart disease rate increased to 65 cases. But authorities have raised objections to this hypothesis.

Dr Stacey Missmer, director of epidemiologic research and reproductive medicine at Brigham’s Women’s Hospital, who co-authored the study said that heart disease patients often report symptoms like difficulty in breathing, chest pains, palpitations, and lightheadedness. Some common heart attack symptoms in women include pain in the upper back, neck or jaw, indigestion, nausea, and palpitations accompanied with a sense of dread. These are sometimes similar for women who have endometriosis.

Causes

Although the exact causes of Endometriosis are not known, probable causes may include-

Painful periods (dysmenorrhea)- Pelvic pain and cramping. This may begin before the commencement of the menstrual cycle and continue afterwards for several days. Ladies also complain about lower back and abdominal pain.
Pain during intercourse – Pain during or after sex is common with endometriosis
Pain with bowel movements or urination
Excessive bleeding- Ladies also complain of occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia)
Infertility – women who are seeking treatment for infertility are also diagnosed for Endometriosis
Other symptoms including fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods

Critics of the study have pointed out that though CHD and endometriosis have common symptoms, the relationship cannot be proved conclusively. They point out that surgical treatments like uterus removal may partly be the cause of the increased rate of heart disease. This is because surgically-induced menopause before natural menopause may be a contributing factor since women with endometriosis tend to have a poor lipid profile.

Emily Reeve, Senior Cardiac Nurse at the British Heart Foundation, explained: “Before the menopause, we know that women generally have a lower risk of being affected by coronary heart disease than they do post-menopause. Having endometriosis can increase the possibility of having a hysterectomy, which can lead to early menopause, so it is possible that this may have influenced the results.”

The researchers concluded that endometriosis was associated with increased risk of coronary heart disease and that the association was strongest among young women. However, the relationship between heart disease and endometriosis is not necessarily one of cause and effect and treatment options such as a hysterectomy with bi-lateral salpingo oophorectomy (removal of the womb, ovaries and fallopian tubes) was also associated with higher risk of coronary heart disease and could partially explain the association between endometriosis and CHD.

My thanks go to Rama Sinha from Sharda Hospital. in Delhi for his help in writing this article.

(Image: courtesy https://pixabay.com/en/users/silviarita-3142410/)