Cardiovascular Health in Women With Endometriosis

Endometriosis and Cardiovascular Health: Expanding the Systemic Profile

Key Points

Highlights: 

• Evidence from observational studies suggests an association between endometriosis and increased cardiovascular disease risk.
• The relationship appears across multiple outcomes, including stroke, coronary heart disease, and composite cardiovascular endpoints.

Importance:

• Recognizing potential cardiovascular implications may broaden the clinical perspective on endometriosis as a condition with systemic health considerations.

What’s done here:

• This study is a systematic review and meta-analysis of published literature through March 31, 2025.
• Ten studies evaluating the association between endometriosis and cardiovascular outcomes were included.

Key results:

• Across included studies, endometriosis was generally associated with higher relative risk estimates for stroke, coronary heart disease, and composite cardiovascular disease.
• The direction of association was consistent, although effect sizes varied between studies.

Strengths and Limitations:

• Synthesizing available epidemiologic evidence across multiple cardiovascular outcomes is the strength of the study.
• The limitations include the observational design of the included studies, potential publication bias, and heterogeneity in diagnostic criteria and adjustment for cardiovascular risk factors.

From the Editor-in-Chief – EndoNews

"Interest in the broader systemic implications of endometriosis has grown substantially, with increasing attention to its potential association with cardiometabolic health. This meta-analysis synthesizes available observational evidence examining cardiovascular outcomes in women with endometriosis and suggests a modest but consistent signal toward elevated risk across several endpoints, including stroke and coronary heart disease. While the magnitude of these associations is relatively small, their consistency across studies raises important questions about shared biological pathways and long-term health trajectories.

Several mechanisms may plausibly contribute to this relationship. Endometriosis is characterized by chronic low-grade inflammation, immune activation, and alterations in lipid metabolism, all of which have been implicated in cardiovascular disease pathogenesis. At the same time, factors such as pain burden, hormonal treatments, and health-seeking behaviors may also influence cardiovascular risk profiles, highlighting the multifactorial nature of the observed associations.

However, the interpretation of these findings must be cautious. The evidence base is composed entirely of observational studies with heterogeneous diagnostic criteria, variable adjustment for confounders, and potential residual bias. Differences in study populations, outcome definitions, and analytic methods limit the ability to draw definitive conclusions about causality or the clinical magnitude of risk. Moreover, the modest effect sizes underscore the importance of contextualizing these findings within the broader spectrum of established cardiovascular risk factors.

Despite these limitations, the analysis contributes to an evolving perspective that endometriosis may extend beyond a localized gynecologic condition to encompass systemic health considerations. Rather than supporting immediate changes in clinical practice, the findings highlight the need for prospective studies integrating detailed cardiovascular phenotyping, longitudinal follow-up, and mechanistic investigation. Such work will be essential to determine whether the association reflects shared risk pathways, downstream consequences of chronic inflammation, or confounding by lifestyle and treatment factors.

In summary, this meta-analysis adds to the growing body of literature suggesting a potential link between endometriosis and cardiovascular health. Its primary contribution lies in consolidating current evidence and framing an important research question: whether endometriosis represents an independent cardiovascular risk context or a marker of broader systemic vulnerability. Clarifying this distinction will be key to guiding future research and informing evidence-based clinical perspectives."

Lay Summary

Women with endometriosis may have a modestly increased likelihood of cardiovascular disease, according to a meta-analysis published in Acta Obstetricia et Gynecologica Scandinavica.

The findings add to growing interest in the potential systemic health implications of endometriosis beyond gynecologic symptoms.

To evaluate the association between endometriosis and cardiovascular outcomes, Dr. Geneviève Plu-Bureau and colleagues from Paris, France, conducted a systematic review of studies published through March 31, 2025.

Ten observational studies met inclusion criteria and were pooled in a meta-analysis.

Across these studies, endometriosis was associated with slightly higher risk estimates for several cardiovascular outcomes. Five studies reported an increased risk of stroke, with a pooled relative risk of 1.18. Four studies found higher risk of coronary heart disease, with a pooled estimate of 1.36, and four studies reported an increased risk of composite cardiovascular disease, with a pooled risk of 1.16.

The authors note that although the direction of association was generally consistent, differences in study design and adjustment for confounding factors warrant cautious interpretation.

They emphasize that further research is needed to clarify whether these associations reflect shared risk factors, underlying inflammatory mechanisms, or other pathways.

Endometriosis has been linked in previous research to chronic inflammation and alterations in lipid profiles, factors that may contribute to cardiovascular risk. However, the observational nature of the available evidence precludes conclusions about causality.

Research Source: https://pubmed.ncbi.nlm.nih.gov/41310987/