Certain gynaecological conditions have been linked to a higher risk of heart and cerebrovascular disease. — Pixabay
Having one or more common gynaecological 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).
These were the findings of a pooled data analysis of the available evidence published online Feb 24 (2025) 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 gynaecological disorders are common and include:
- Polycystic ovary syndrome (PCOS)
- Endometriosis – where tissue similar to the womb lining grows outside of the womb, and bleeds during the period
- 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.
These disorders significantly affect women’s health and well-being.
Previously-published research indicates that they may be associated with heart or cerebrovascular disease, add the researchers.
To explore this further, they scoured research databases looking for relevant studies published up to last 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, PCOS, 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 higher risk (28%) of heart 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 heart and cerebrovascular disease, and each of its components, was higher among those with a history of endometriosis or PCOS.
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.
The latter is largely because of the lack of adequate consideration of potentially influential factors.
And several aspects of heart 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 heart and cerebrovascular disease, and common gynaecological disorders, including systemic inflammation and oestrogen production.
There may also be an overlap between gynaecological risk factors and heart risk factors, they suggest, pointing out that metabolic syndrome is often present in people with PCOS for example.
“The association between [heart and cerebrovascular disease] and [common gynaecological disorders] requires further exploration with high-quality longitudinal studies adjusted for confound-ers 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 profes-sionals to advise patients regarding risk-reducing behavioural changes and interventions, to potentially prevent or delay the onset of, or reduce the severity of [heart and cerebrovascular disease].”
