According to an analysis of aggregated data from available evidence conducted by the Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom, in collaboration with McMaster University, Canada, having one or more common gynecological disorders, such as endometriosis or heavy or irregular menstrual periods, may be associated with a higher risk of heart disease and conditions affecting blood flow to the brain (cerebrovascular disease).
The results are available in the journal ‘Heart’. Although the quality of the studies included in the analysis was variable, the researchers conclude that doctors and the public should be more aware of these associations to potentially mitigate risks.
Long-term non-cancerous gynecological disorders are common and include polycystic ovary syndrome (PCOS), endometriosis (where tissue similar to the lining of the uterus grows outside the uterus), adenomyosis (where the lining of the uterus grows into the muscular wall), uterine fibroids, primary dysmenorrhea (painful menstrual cramps), chronic pelvic pain, irregular and/or very heavy periods, and abnormal uterine bleeding, explain the researchers.
These disorders significantly affect the health and well-being of women, and previously published studies indicate that they may be associated with cardiovascular or cerebrovascular diseases, they add.
To further explore this, researchers searched research databases for relevant studies published up to April 2024. Out of an initial total of 59 studies, 28, involving 3,271,242 women, were eligible for a systematic review and inclusion in the aggregated data analysis. The studies included in the analysis only identified endometriosis, polycystic ovary syndrome, heavy periods, and irregular menstrual cycles.
WHAT IS THE CARDIOVASCULAR RISK?
Overall, the aggregated data analysis of the study results showed that, compared to people without any of these conditions, those who had at least one had a significantly higher risk (28%) of cardiovascular and cerebrovascular disease. Specifically, their risk of developing ischemic heart disease was 41% higher, while their risk of developing cerebrovascular disease alone was 33% higher.
Subsequent analysis indicated that the overall risk of cardiovascular and cerebrovascular disease and each of their 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 more than half (53.5%) of the studies were rated as very high risk of bias, largely due to inadequate consideration of potentially influential factors.
INCREASE AWARENESS
Furthermore, several aspects of cardiovascular disease were not covered by the included studies, such as atrial fibrillation (abnormal heart rhythm). Nevertheless, the researchers suggest that there may be plausible biological pathways linking cardiovascular and cerebrovascular diseases with common gynecological disorders, including systemic inflammation and estrogen production.
There may also be an overlap between gynecological risk factors and cardiovascular risk factors, they suggest, noting that metabolic syndrome is often present in people with polycystic ovary syndrome, for example.
However, they conclude: «Although the extent of this association still needs to be explored, and causality has not been established, the findings suggest that it is important to increase awareness of the potential association, both in the general public and in healthcare professionals.»
