Neurological

Does Endometriosis Up Risk for Stroke in Women Later in Life?

Women with endometriosis are likely to be at an increased risk for stroke compared with women without endometriosis, according to a prospective cohort study published in Stroke.

Endometriosis is a chronic inflammatory gynecologic condition which affects an estimated 10% of women. Mounting evidence indicates that women with endometriosis may be at increased risk for cardiovascular disease (CVD) in later life, due to a milieu of endogenous inflammation and immunologic and hormonal perturbations.

For the study, researchers from the University of Arizona sought to evaluate the endometriosis-specific risk for stroke. They sourced data for this analysis from the Nurses’ Health Study II (NHSII) which was a cohort study that followed women between 1989 to 2017. Risk for stroke was evaluated on the basis of laparoscopically confirmed endometriosis.

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At baseline, women with (n=5244) and without (n=106,812) endometriosis were aged mean 36 (standard deviation [SD]4.2) and 34.7 (SD, 4.7) years, 56.1% and 57.6% were 12-13 years of age at menarche, 86.7% and 90.0% had regular menstrual cycles, 54.0% and 16.5% had infertility, 10.7% and 17.0% never used oral contraceptives, 41.5% and 29.7% were nulliparous, and 27.4% and 24.1% had a family history of stroke, respectively.

Over the 2,770,152 person-years follow-up, 893 incident stroke events occurred.

Compared with women who did not have endometriosis, the women with endometriosis were at increased risk for stroke (adjusted hazard ratio [aHR], 1.34; 95% CI, 1.10-1.62).

The relationship between stroke and endometriosis was mediated by hysterectomy or oophorectomy (39.0%; P ≤ .0001), hormone therapy use (15.5%; P = .01), history of hypertension (8.4%; P ≤ .0001), and history of high cholesterol (4.9%; P=.003).

This study was not able to account for all endometriosis treatments which may have affected stroke risk.

The study authors concluded that women with endometriosis may be at increased risk for stroke. The researchers advised, “Women and their health care providers should be aware of endometriosis history, maximize primary cardiovascular prevention, and discuss signs and symptoms of cardiovascular disease.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Farland LV, Degnan WJ III, Bell ML, et al. Laparoscopically confirmed endometriosis and risk of incident stroke: a prospective cohort study. stroke Published online July 21, 2022. doi:10.1161/STROKEAHA.122.039250

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