Extensive prospective research investigated the data from 112,056 women in 28 years, to check if women with endometriosis were more at risk of having a stroke. However, the researchers specified that although it is important to study a possible correlation between stroke and women with endometriosis, the chances that an individual will suffer a stroke during her life are very low.
The research results were published in the scientific journal Stroke, newspaper of the American Stroke Association, which is a division of the American Heart Association.
Women with endometriosis: is there a correlation with stroke?
The scientific community recognizes that about 10% of women of reproductive age are affected by endometriosis, a chronic and often painful condition in which tissue-like tissue lining the uterus grows outside that organ. Previous studies, such as one research of 2016revealed that endometriosis is associated with an increased risk of coronary heart disease.
“Previous research by our team has observed an association between endometriosis and increased risk of hypertension, high cholesterol and myocardial infarction,” he said. Leslie Farlandfirst author of the new research and assistant professor of epidemiology and biostatistics at theUniversity of Arizona in Tucson“Since these conditions are associated with stroke risk, we wanted to understand whether women with endometriosis also had a high risk of stroke,” continued Professor Farland.
The team of researchers developed the new research to overcome the limitations found in other studies of women with endometriosis and the increased risk of contracting a stroke, which included follow-up of participants for short periods and limited accounting for the potential of patients. confounding factors.
In order to carry out their study, the researchers carefully studied the information of the volunteers who participated in the Nurses’ Health Study II (NHSII): 116,429 women who were nurses between the ages of 25 and 42 in 1989. Participants in the NHSII were offered questionnaires every two years until 2017. These questionnaires covered questions about diseases and risk factors.
In a second step, the research team excluded NHSII participants who had a stroke, myocardial infarction, cancer (other than non-melanoma skin cancer), or a coronary bypass graft before June 1989 or who received a diagnosis of endometriosis not confirmed by the laparoscope. This skimming reduced the volunteers who participated in the research to 112,056, of whom 5,244 were women with endometriosis. Among the selected participants, there were 893 stroke episodes over 28 years of follow-up.
Researchers used models adapted for possible risk factors, including the volunteers’ alcohol intake, adolescent menstrual cycle and physical activity. Not only that, the team of scientists evaluated whether the risk of stroke could be influenced by other factors such as hypertension, hysterectomy and postmenopausal hormone therapy, the so-called TOS.
Thanks to this in-depth research, the team revealed that women with endometriosis had a 34% higher risk of stroke than women without a history of endometriosis in models adjusted for potential confounders: “This is important to note, but not an exceptionally high risk increase, ”he clarified Stacey Missmer, co-author of the study and Professor of obstetrics, gynecology and reproductive biology at the Michigan State University College of Human Medicine: “Furthermore, the absolute risk of stroke for any individual in his life still remains quite low.”
The researchers also found that the association between women with endometriosis and increased risk of stroke is partially mediated by hysterectomy (removal of the uterus) or ovariectomy (removal of the ovaries): “We were able to calculate that around 40 % could be caused by the high prevalence of hysterectomy, with and without ovariectomy, but that means there is an additional 60% that cannot be attributed to that, there must be other factors at play, ”explained Professor Missmer.
The association was also partially mediated by postmenopausal hormone therapy, from the onset of menopause at age 45 or earlier, and a history of hypertension or high cholesterol. No significant differences were observed in the relationship between endometriosis and stroke in multiple factors including age, body mass index, or history of infertility. For this study, most of the participants (93%) were white women. However, Professor Farland explained that “we would expect the results of our study to be generalizable to other racial and ethnic groups.”
The Doctor Ken Sinervomedical director of the Center for Endometriosis Care in Atlanta, specified that endometriosis is too often: “poorly managed by hysterectomy, which in many cases may not be necessary. The result is an increased risk of cardiovascular disease, which otherwise could be largely avoided with proper use of laparoscopic excision, ”added Sinervo, referring to the procedure in which a surgeon makes small incisions in the patient’s lower abdomen. Through these, surgeons will insert a camera to look for endometriosis lesions which will later be removed using a laparoscope.
Professor Missmer hopes this study will raise awareness among healthcare professionals and women with endometriosis about the risks of hysterectomy: “As this evidence builds a relationship between that particular surgery and other increased risk factors throughout life, women with endometriosis they need to be more aware that there may be these other impacts of having those surgeries and even the doctors who care for them need to be aware of this information as well.
In addition, Professor Missmer stressed that it is important for health care professionals and patients with endometriosis to be aware that women with cobendometriosis can impact cardiovascular and cerebrovascular health: “It means that primary care physicians, not just gynecologists, must monitor and pay attention to all symptoms and risk factors of a patient with endometriosis ”concluded Professor Missmer.
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