Conditions like endometriosis, heavy or irregular periods, and PCOS may be connected with blood vessel problems, scientists say. 

“While the degree of this increased risk varied across individual studies, the overall picture strongly suggests that people with these conditions may be more likely to experience events like heart disease or stroke,” says coauthor Mathew Leonardi, MD, PhD, an assistant professor of obstetrics and gynecology at McMaster University in Ontario, Canada.

Endometriosis and PCOS Pose the Greatest Risk to Heart and Brain Health

The research was a systematic review and meta-analysis, which means it combined the results from multiple smaller studies as a way to get clearer picture of the relationship between non-cancer-related gynecologic disorders — specifically endometriosis, polycystic ovary syndrome, heavy periods, and irregular menstrual cycles — and heart disease and cerebrovascular disease (involving blood flow in the brain).

Researchers found 28 relevant studies published through April 2024, with over 3.2 million total participants.

Key findings include:

• Compared with people without one of these conditions, those who had at least one gynecologic disorder had a 28 percent higher risk of cardiovascular and cerebrovascular disease.
• The risk of ischemic heart disease (heart damage caused by narrowed heart arteries) was 41 percent higher.
• The risk of cerebrovascular disease alone was 33 percent higher. This includes conditions such as stroke, brain aneurysm, brain bleed, and carotid artery disease.
• Women with PCOS, endometriosis, or both faced the highest overall risk.

Analysis Highlights Lack of Quality Research on Gynecologic Health

The researchers acknowledged that the overall quality of the studies included in the analysis varied considerably, and over half of the studies were scored as having a very high risk of bias.

“Another key takeaway is the need for better, more consistent research — many of the studies we included had limitations. Still, taken together, the data point to a relationship worth paying attention to in both clinical practice and future research,” says Dr. Leonardi.

Abha Khandelwal, MD, a clinical associate professor of medicine and women’s heart health specialist at Stanford Medicine in California, also points out the need for better research in this area. Dr. Khandelwal wasn’t involved in the study.

“Only 21 percent of the reviewed studies had good design and low risk of bias, and several of the reviewed studies had bias, and there are likely several confounders which were not adjusted for,” she says.

That means those studies didn’t control for other key factors that could influence the risk of heart disease and stroke.

“In order for science to move forward and to understand all the associations and potentially modifiable risk factors for women, it is critical to fund good quality research in this field and for women to participate in these studies. I hope this will serve as a call to action for women to advocate for better research in these areas and for them to continue to work on controlling their risk factors for heart disease and cerebrovascular disease,” says Khandelwal.

What Could Be Behind the Link?

This study wasn’t set up to uncover the potential “why.” Based on the diseases and not on the study findings, there could be a few potential connections, says Khandelwal.

• PCOS and cerebrovascular disease have similar inflammatory pathways and risk factors.
• There are several ways these gynecologic conditions may interfere with a heart-healthy lifestyle. For example, if you have severe period pain, you may be less inclined to exercise.
• If you have irregular cycles, this may be due to variations in your sex hormones. “We know this can influence endothelial cell function,” she says. Endothelial cells line the inside of blood vessels and help regulate blood flow.

“We also can’t overlook treatments and surgeries used to treat these gynecological conditions. For instance, certain hormonal therapies or procedures like hysterectomy may themselves influence the long-term risk of heart disease and stroke,” says Leonardi.

How Should Women With PCOS and Endometriosis Manage Potential Increased Risk?

Leonardi emphasizes that although these findings suggest a link, it’s not “ironclad proof of a direct cause-and-effect relationship,” and more research is needed.

“If you have a gynecological condition, it doesn’t mean you’re destined to develop heart or cerebrovascular disease — just that it’s wise to pay extra attention. The message here is about being proactive but not alarmed,” says Leonardi.

He offers the following tips:

• Talk to your healthcare team about cardiovascular risk factors: Ask about your blood pressure, cholesterol, and blood sugar levels, especially if you have PCOS, endometriosis, or other chronic gynecologic conditions.
• Adopt healthy lifestyle habits, such as staying physically active, eating a balanced diet, and avoiding smoking.
• If you’re on hormonal treatments, or if you’ve had surgeries like a hysterectomy or oophorectomy (ovary removal), be sure to review these with your providers to assess how they might interact with your cardiovascular health.

“If possible, participate in trials to advance further understanding of these disease processes,” says Khandelwal.