Endometriosis is a chronic inflammatory gynecological disease that affects an estimated 10% (190 million) of reproductive-age women and is characterized by endometrial-like tissue present outside of the uterus, resulting in severe pelvic pain, heavy bleeding during or between periods, bloating and nausea, fatigue, depression or anxiety, as well as infertility, in some cases. Historically, endometriosis was believed to be a gynecological disease that only affected women and emerged from retrograde menstruation; however, emerging studies indicate that this definition is outdated and neglects the true manifestations of the disease.

Authors from a study published in The Lancet explained that endometriosis is a systemic disease that affects metabolism in liver and adipose tissue, leading to systemic inflammation and altering gene expression in the brain that causes pain sensitization and mood disorders. Their definition recognizes the diseases manifestations and complications beyond the pelvis, opening doors for improved understanding and treatment.

As acknowledgment of the disease as truly being systemic grows, its many impacts on the other organ systems are being discovered. In a separate study, authors aimed to evaluate endothelial dysfunction, arterial stiffness, and skin advanced glycation end-products (AGEs) accumulation in patients with endometriosis, which has been largely understudied. They hypothesized that these complications lead to the risk and prevalence of ischemic heart disease, cerebrovascular disease, heart failure, dyslipidemia, arrhythmias, and stroke in patients with endometriosis.

In the study, the authors matched the age, body mass index, and blood pressure values of 21 patients with endometriosis and 24 healthy controls. They used an Endo-PAT 2000 device for non-invasive assessment of endothelial function, expressed as Reactive Hyperemia Index (RHI), and arterial stiffness, expressed as Augmentation Index (AI) and Augmentation Index at 75 heart beats/min (AI75). An AGE Reader device was used for non-invasive evaluation of skin AGE level accumulation.

According to the results, patients with endometriosis had lower mean RHI values (1.69 ± 0.54 vs. 2.02 ± 0.48, p = 0.037) and a higher prevalence of endothelial dysfunction, (52.4% vs. 20.8%, p = 0.027) compared with healthy controls, as well as higher skin AGE levels (2.00 ± 0.57 vs. 1.70 ± 0.24, P = 0.013). Both endothelial dysfunction and elevated AGE skin accumulation are well-known preclinical indicators of increased CVD risk.

The findings support the complexity of endometriosis and its impact on various parts of the body, as well as suggest a greater need for comprehensive CVD risk assessment in patients with endometriosis. The initial findings add to the growing body of evidence redefining endometriosis and dispelling common misconceptions around the disease, creating more opportunities for research and treatment.

REFERENCES

1. Smyk J, Danielecka Z, Kotowska M, et al. Cardiovascular risks and endothelial dysfunction in reproductive-age women with endometriosis. Sci Rep. October 15, 2024. doi:10.1038/s41598-024-73841-7

2. Endometriosis. World Health Organization. March 24, 2023. Accessed October 18, 2024. https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Overview,period%20and%20last%20until%20menopause

3. Endometriosis is more than just ‘painful periods.’ Yale Medicine. August 17, 2023. Accessed October 18, 2024. https://www.yalemedicine.org/news/endometriosis-is-more-than-painful-periods

4. Taylor H, Kotlyar A, Flores V. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. The Lancet. doi:10.1016/S0140-6736(21)00389-5

5. Farland L, Degnan W, Bell M, et al. Laparoscopically confirmed endometriosis and risk of incident stroke: a prospective cohort study. Stroke. July 21, 2022. doi:10.1161/STROKEAHA.122.039250