Exploring the Connection Between Gynecological Conditions and Increased Risk of Heart Disease and Stroke

Having one or more common gynecological disorders such as endometriosis or heavy/irregular periods may increase a woman’s risk of heart disease and conditions that affect blood flow to the brain (cerebrovascular diseases), according to a pooled data analysis of existing research published online in the journal Heart. Despite varying study qualities, researchers concluded that greater awareness is needed among clinicians and the public about these associations to help mitigate potential risks.

Long-term non-cancerous gynecological disorders are common. These include polycystic ovary syndrome (PCOS), endometriosis (where womb lining tissue grows outside of the uterus), adenomyosis (womb lining growth into muscular wall), uterine fibroids, primary dysmenorrhoea (painful menstrual cramps), chronic pelvic pain, irregular or very heavy periods, and abnormal uterine bleeding. These conditions significantly affect women’s health and wellbeing.

Previous research has indicated that these disorders may be linked to cardiovascular or cerebrovascular disease. To explore this further, researchers conducted a comprehensive search for relevant studies published up to April 2024 from databases of academic papers. From an initial set of 59 studies, only 28 involving over three million women were eligible for systematic review and inclusion in the pooled data analysis.

The conditions covered by these included studies were endometriosis, PCOS, heavy periods, and irregular menstrual cycles. The pooled data analysis showed that women with at least one of these disorders had a significantly higher risk (28%) of cardiovascular and cerebrovascular diseases compared to those without. Specifically, their risk of ischaemic heart disease was 41% higher, while the risk for cerebrovascular disease alone was 33% higher.

Further analysis revealed that women with endometriosis or PCOS had an even greater overall and component-specific (cardiovascular/cerebrovascular) risks. However, researchers noted significant variations in study design and methodology, with over half having a very high risk of bias due to inadequate control for influential factors.

Several aspects of cardiovascular disease were not covered by the included studies, such as atrial fibrillation. Nonetheless, plausible biological pathways linking these diseases and gynecological disorders—like systemic inflammation and oestrogen production—are proposed. There may also be overlaps between gynecological risk factors and traditional cardiovascular risk factors.

The researchers emphasize that more high-quality longitudinal studies adjusted for confounders are needed to establish temporal relationships and causality in the association between these conditions. Despite this, they stress: “Although the extent of this association is still being explored, and causation has not been established, the findings suggest it’s important to raise awareness about potential associations… both among the general public and healthcare professionals.”

Raising such awareness could lead to advice for patients on risk-reducing behavioral changes or interventions that may help prevent or delay the onset of cardiovascular and cerebrovascular diseases.