Increased Risk of Stroke Due to Endometriosis
A stroke results from a brain’s blood circulation disruption, typically stemming from a vascular blockage or a ruptured vessel within brain tissue [1]. This interruption deprives specific brain regions of the oxygen and nutrients they require, potentially leading to the death of the tissue within a few hours [2].
What Does the Study Reveal?
In this United States-based study, epidemiologists explored the connection between endometriosis and the risk of stroke.
The research drew upon data from the Nurses’ Health Study II (NHSII), a cohort study spanning nearly 28 years. Within this period, participants, aged 25 to 42 years, were meticulously screened for stroke occurrences from 1989 to 2017, with adjustments made for potential confounding factors.
The study uncovered a significant finding: among approximately 2,800,000 person-years of observation, 893 stroke cases were documented. Notably, women with laparoscopically confirmed endometriosis exhibited a 34% higher risk of stroke than their counterparts without endometriosis. This association was predominantly influenced by hysterectomy/oophorectomy, postmenopausal hormone therapy, and early menopause (before age 45). Conversely, no significant disparities emerged in the relationship between endometriosis and stroke concerning age, infertility, body mass index, or menopausal status.
It is important to note that the study did not provide information on specific stroke subtypes.
The increased stroke risk observed in women with endometriosis may be attributed to an elevated hyperinflammatory state characterized by heightened levels of inflammation in the bloodstream. Additionally, the study found a correlation between endometriosis and a higher likelihood of a family history of myocardial infarction or stroke [3], [4].
Good to Know!
Possible confounding variables considered in the analysis encompassed a range of factors, including alcohol consumption, body mass index during adolescence, current body mass index, age at onset of menstruation, menstrual patterns during youth, present menstrual characteristics, parity (number of pregnancies carried to term), historical use of oral contraceptives, previous smoking habits, dietary quality, physical activity level, utilization of NSAIDs (non-steroidal anti-inflammatory drugs), aspirin intake, racial or ethnic background, and participant income.
How to Identify the Signs of a Stroke
A stroke may manifest with symptoms like dizziness, paralysis, and difficulties in speech and vision. However, it is crucial to recognize that these signs can vary between genders, with women often displaying symptoms not typically associated directly with strokes [5]. These atypical symptoms can include shortness of breath, difficulty swallowing, hiccups, chest pain, headache, nausea, and confusion. It is important not to dismiss the possibility of a stroke when several of these indicators co-occur [6].
When stroke symptoms become apparent, swift action is paramount. Seeking immediate medical attention is crucial.
To aid in recognizing a stroke, especially in women, you can remember the acronym F.A.S.T.:
F = Face: Is one side of the face drooping when smiling?
A = Arms: Does one arm drift downward when both arms are raised?
S = Speech: Is speech slurred or unusual when repeating a simple sentence?
T = Time: If you observe any of these signs, do not delay; call for an ambulance right away [7]!
What Are the Risk Factors?
In general, stroke affects women more frequently than men, underscoring the importance of recognizing gender-specific strategies for prevention and treatment [5]. Research indicates that postmenopausal women, particularly those over 65, face an elevated risk of stroke [7]. Beyond experiencing higher mortality rates than men, women are more prone to disability, depression, and dementia following a stroke. Pregnancy, the postpartum period, and increasing age are notable pathophysiological aspects contributing to stroke risk in women [7].
- High blood pressure (especially during pregnancy)
- Hormone-related factors (such as birth control pills or hormone replacement therapy during menopause)
- Pregnancy
- Elevated body weight or obesity
- Hypertension
- Diabetes mellitus
- Atrial fibrillation
- Smoking and alcohol consumption
- Elevated blood cholesterol levels
- A family history of stroke or heart attack [2].
How Can I Take Preventive Measures?
NHSII recommends prioritizing primary cardiovascular prevention and discussing cardiovascular disease symptoms openly with healthcare professionals [3]. Additionally, you can incorporate preventive actions into your daily routine to lower the long-term risk of stroke. These measures include:
- Maintaining a diverse and healthy diet.
- Establishing a regular exercise routine (or staying as active as possible and minimizing sedentary time).
- Limiting or ceasing alcohol consumption and smoking.
- Considering medications that may help reduce the risk of experiencing another stroke [8].
Should every individual with endometriosis be concerned about stroke risk now?
No, the risk of stroke is generally low for most individuals and depends on various factors. So, even if the risk increases slightly, it typically remains low.
It is essential to consider all risk factors comprehensively. Nevertheless, staying informed about other risk factors and knowing when it is appropriate to discuss them with your healthcare provider can be beneficial.
In a Nutshell
The NHSII cohort study revealed a 34% higher risk of stroke among women with endometriosis. Nonetheless, the study highlights the limitations of current research in this area, including short follow-up periods, limited consideration of potential confounders, and reproductive health history.
It is important to recognize stroke symptoms and risk factors with a gender-specific approach and tailor prevention and treatment strategies for each gender.
With the Endo-App, you can record your daily well-being.
References
- Centers for Disease Control and Prevention. Women and Stroke. Available from: https://www.cdc.gov/stroke/women.htm. Accessed November, 15, 2022.
- DEGAM Patienteninformation. Schlaganfall vorbeugen, erkennen und behandeln. Available from: https://www.degam.de/files/Inhalte/Leitlinien-Inhalte/Dokumente/DEGAM-S3-Leitlinien/053-011_Schlaganfall/053-011PI_LL_Schlaganfall.pdf. Accessed November, 15, 2022.
- Farland LV, Degnan WJ 3rd, Bell ML, Kasner SE, Liberman AL, Shah DK, Rexrode KM, Missmer SA. Laparoscopically Confirmed Endometriosis and Risk of Incident Stroke: A Prospective Cohort Study. Stroke. 2022 Oct;53(10):3116-3122. doi: 10.1161/STROKEAHA.122.039250. Epub 2022 Jul 21. PMID: 35861076; PMCID: PMC9529799.
- Bublak, R. Endometriose ist mit erhöhtem Schlaganfallrisiko assoziiert. gynäkologie + geburtshilfe27 (Suppl 1), 16 (2022). https://doi.org/10.1007/s15013-022-4480-3
- Carcel C, Woodward M, Wang X, Bushnell C, Sandset EC. Sex matters in stroke: A review of recent evidence on the differences between women and men. Front Neuroendocrinol. 2020 Oct;59:100870. doi: 10.1016/j.yfrne.2020.100870. Epub 2020 Sep 1. PMID: 32882229.
- Die Techniker. Schlaganfall bei Frauen. Available from: https://www.tk.de/techniker/magazin/life-balance/themenspecials-life-balance/frauengesundheit/schlaganfall-bei-frauen-2126654. Accessed November, 15, 2022.
- Pezzella FR, Santalucia P, Vadalà R, Giugni E, Zedde ML, Sessa M, Anticoli S, Caso V; Women Stroke Association. Women Stroke Association Statement on Stroke. Int J Stroke. 2014 Oct;9(SA100):20-27. doi: 10.1111/ijs.12110. PMID: 28051365.
- Patient education: Ischemic stroke treatment (Beyond the Basics). Available from: https://www.uptodate.com/contents/ischemic-stroke-treatment-beyond-the-basics/print. Accessed November, 15, 2022.
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