Endometriosis and Risk of Coronary Heart Disease

Study Questions:

Is endometriosis associated with coronary heart disease (CHD)?


Data from the Nurses’ Health Study II (1989–2009) were used for the present analysis. This cohort includes 116,430 registered female nurses, ages 25-42 years, at time of enrollment in 1989, all residing in the United States. Women with a history of CHD and stroke at baseline were excluded. The remaining participants were followed for first diagnosis of CHD including myocardial infarction (MI), confirmed angina, and revascularization through 2009. The primary exposure of interest was laparoscopically confirmed endometriosis, which was first assessed by questionnaire in 1993.


Over the 20 years of follow-up, 1,438 cases of CHD were identified, and 5,296 women had laparoscopically confirmed endometriosis. These women were older, had earlier age at menarche, were more likely to be nulliparous, had lower parity, were more likely to use oral contraceptives, and more likely to have a family history of MI at ages <60 years, compared with women who had not been diagnosed with endometriosis at baseline. Compared to women without endometriosis, women with endometriosis had a greater risk for CHD (relative risk [RR], 1.62; 95% confidence interval [CI], 13.9-1.89). For each specific CHD condition, the risk was greater for women with endometriosis including for MI (RR, 1.52; 95% CI, 1.17-1.98), for angina (RR, 1.91; 95% CI, 1.59-2.29) confirmed by angiography, and for revascularization (coronary artery bypass grafting or percutaneous coronary intervention) (RR, 1.35; 95% CI, 1.08-1.69) after adjustment for demography factors, family history, and lifestyle and anthropometric characteristics. The risk of CHD appeared to vary by age with the highest risk observed among women 40 years of age or younger (RR, 3.08; 95% CI, 2.02-4.70). As women aged, the CHD risk associated with endometriosis declined. Having had a hysterectomy/oophorectomy was associated with higher risk of combined CHD compared with not having had a hysterectomy/oophorectomy (RR, 1.51; 95% CI, 1.34-1.71).


The investigators concluded that in this large, prospective cohort, laparoscopically confirmed endometriosis was associated with increased risk of CHD. The association was strongest among young women. Hysterectomy/oophorectomy was associated with higher risk of CHD and could partially explain the association between endometriosis and CHD.


This large-scale prospective study suggests that women with confirmed endometriosis are at increased risk for CHD; thus, we may wish to consider more aggressive primary prevention in such women. Further study which includes interventions to lower risk, along with a diverse population of women, is warranted.

Keywords: Angina Pectoris, Angiography, Contraceptives, Oral, Coronary Artery Bypass, Coronary Artery Disease, Endometriosis, Hysterectomy, Myocardial Infarction, Parity, Percutaneous Coronary Intervention, Primary Prevention, Risk

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