Endo has your heart 💔

How Endometriosis impacts the Cardioprotective Nature of Estrogen and Progesterone

This week’s edition is a little different. It has been adapted from an article that I recently wrote but realised you folks might enjoy reading it too!

I’ve ofsource rehashed it to make it more interesting for you, but bear in mind that it’s a little different than what we do every week.

With that said, let’s begin!

Endometriosis is a disease that affects nearly one in every ten women across the world. It is a serious condition in which tissue similar to the lining of the uterus grows outside the uterus, causing severe pain in the pelvis, affecting a woman’s fertility and the natural pregnancy. 

As a chronic disease, one of the most serious concerns with Endometriosis and why it requires a high level of societal awareness is that the average amount of time it takes globally for a woman to be diagnosed with Endometriosis is 6 to 7 years.

When left unchecked for years, it takes a heavy toll on the body by causing hormonal imbalances, loss of elasticity in the blood vessels and a buildup of plaque, increasing the risk for several serious health concerns. 

That’s why as a fraternity, it's critically important to bring more education about Endometriosis to the public sphere, to improve women’s lives, their overall wellbeing and quality of life.

As a Women’s Hospital and a dedicated centre of excellence for Endometriosis, we want to do as much as possible to build awareness for this disease and impart education on the same while talking about risk factors associated with Endometriosis and how women can better understand and prepare themselves against this disease.

Recent Findings

Recently, a report published in CMAJ Open by lead author Jessica Blom, a fourth year resident with the department of obstetrics and gynaecology at Queen’s University, revealed crucial findings that showed a direct correlation between Endometriosis and a risk for heart diseases.This study used administrative health data from Ontario residents from 1993 to 2015 in which 166,835 females with endometriosis were included and matched to 333,706 females without endometriosis. The primary outcome of studying this data revealed hospitalisation due to CVD, which included heart attack, stroke, heart failure, and several other types of heart disease.

The Hormones

Adding on to these findings, we wanted to talk about the cardioprotective nature of Estrogen and Progesterone. Since it is exactly this cardioprotective nature of the Estrogen and Progesterone hormones that is disrupted when Endometriosis is present.

Source: onlinelibrary.wiley.com/doi/10.1155/2021/5523516

We need to understand that Endometriosis not only impacts a woman's reproductive health but may also increase her risk for heart diseases.

But How?

The short answer lies in hormones and how interconnected everything in the body is. The brain has a region called Hypothalamus in the limbic system, which is key to hormone regulation. One of its functions is to produce a hormone called GnRH (Gonadotropin-releasing hormone). This hormone acts as a signal carrier to the anterior pituitary, which then stimulates the release of two important hormones: FSH (Follicle-stimulating hormone) and LH (Luteinizing hormone). These two hormones are crucial in communicating with the ovaries.

biorender.com

Ovaries, as we know, produce hormones such as estrogen and progesterone, which don’t just regulate menstruation and fertility but play a vital role in protecting a woman’s cardiovascular system. Estrogen, in particular, has been shown to have cardio-protective properties. It helps in maintaining healthy blood vessels by promoting elasticity in the arteries, preventing plaque buildup, and maintaining favourable cholesterol levels. Progesterone also plays a role in balancing the effects of estrogen, contributing to overall cardiovascular health.

The Twist

However, when endometriosis starts to grow within the ovaries, it affects both the outer (cortex) and inner (medulla) parts of these hormone-producing organs. This disrupts the natural balance of estrogen and progesterone, creating a hormone imbalance. 

In short, endometriosis interferes with ovarian function, leading to a disruption in hormone production. Since hormones like estrogen are essential for heart health, this disruption can make women with endometriosis more susceptible to cardiovascular issues. By understanding this hormonal connection, we can better appreciate why managing endometriosis is about more than just reproductive health—it’s about a woman’s overall well-being, including her heart health.

The Turn

Since Endometriosis is a disease that affects the ovaries, it grows inside the ovaries and on the ovaries, affecting the cortex and medullary part of it, hence affecting the overall hormone functionality. This further disrupts the Estrogen - Progesterone Hormonal axis which are cardioprotective in nature for the women. And the cardioprotective nature of the Estrogen and progesterone is therefore disrupted in Endometriosis.

Source: link.springer.com/article/10.1007/s00018-023-04894-6

Conclusion

Understanding this connection between the cardioprotective nature of these essential hormones and their overall connection with the limbic system is crucial to understanding that Endometriosis doesn’t just impact a woman’s fertility but it can also seriously affect her overall health and general wellbeing by causing complications that go beyond pregnancy, sexual health and the severe pain which is brought on by this condition.

That’s it for this week!