Study Shows that Women with PCOS and Painful Periods Have a Higher Risk of Heart Disease

New research suggests that women suffering from specific menstruation disorders may be at a higher risk for heart disease.

Periods often come with such unpleasant symptoms as cramps and nausea. However, additional menstruation disorders can exacerbate these symptoms.

Polycystic ovary syndrome (PCOS) and dysmenorrhea are two common menstruation disorders. PCOS is a hormonal disorder affecting the female reproductive system and can lead to irregular or missed periods, excessive hair growth, severe acne, infertility, and weight gain. It impacts between 6-12% of women in the United States.

Dysmenorrhea is another term for incredibly painful period cramps and it's often the result of other health conditions such as uterine fibroids, tumors, endometriosis, pelvic inflammatory disease, adenomyosis, or uterine polyps. The prevalence of dysmenorrhea varies between 16% and 91% among individuals with ovaries, with severe pain affecting around 2% to 29%.

Both of these disorders are generally more prevalent in younger individuals. Recent, preliminary studies have found these menstruation disorders to be linked with a higher risk of cardiovascular disease.

These study findings were revealed at the American Heart Association's Scientific Sessions 2023 earlier this month. As Dr. Eugenia Alleva, an author of one of the studies, said, examining menstruation-related factors is crucial because they particularly affect the younger female population, a group for which current risk prediction models typically perform poorly.

This research aims at understanding how these menstrual disorders are associated with cardiovascular health and identifying ways to relieve their symptoms.

The initial study involved 30,500 individuals, with and without ovaries, with dysmenorrhea, which aimed to understand how this condition is related to the prevalence of heart disease.

According to Dr. Alleva, examining dysmenorrhea is particularly important as it is the most common menstrual complaint and has been linked to heightened stress, disruption of the autonomic nervous system (which affects the heart and blood vessel function), and increased inflammation-related molecules.

The investigators analyzed heart disease diagnosis before the age of 50 in participants who also had heart attacks, chronic heart disease, and abnormal menstrual conditions like skipped periods, heavy bleeding, and endometritis. They discovered that participants with dysmenorrhea were more likely to develop chronic ischemic heart disease, a condition characterized by reduced blood and oxygen supply to the heart due to narrowed blood vessels.

The focus of the investigation was to identify cardiovascular risk rather than understanding the cause of such risk. Nevertheless, Dr. Alleva hypothesizes that inflammation and stress are possible contributing mechanisms as they are linked to increased cardiovascular risk. Stress, in particular, is relevant to ischemic heart disease in young women.

In a subsequent study, involving nearly 17,000 young individuals with ovaries, it was found that those with PCOS had a 30% higher risk of hypertension compared to those without PCOS. The study also concluded that PCOS is connected to a 1.3-fold higher risk of having a hypertensive blood pressure reading of greater than 130/80 mm Hg.

PCOS is synonymous with more than just a gynecological disorder, as noted by Dr. Sebastian Mirkin, a reproductive endocrinologist and women's health clinical research lead at Organon. High androgen levels trigger insulin resistance, which prevents the ovaries from releasing eggs, causing irregular menstrual cycles and infertility.

Dr. Mirkin highlighted that individuals with PCOS are at a great risk of obesity, hypertension, and other conditions that potentially increase the risk of cardiovascular disease.

As he explained, metabolic disease is the most common type of PCOS, which can cause hypertriglyceridemia, hypertension, obesity, and an increased risk of type 2 diabetes.

Why do these menstrual disorders seem to be linked to cardiovascular health? The studies aimed to answer this.

“Menstruation is a complex process related to several physiological body systems, including hormonal axes, coagulation, nervous system, and others,” Alleva said. “Menstrual characteristics and menstrual disorders are therefore interesting to study since the mechanisms behind these disorders might have effects beyond the reproductive systems, including the cardiovascular system.” 

Alleva explained that the research teams performed both cross-sectional and longitudinal analyses of electronic health records employing statistical methods rooted in causal inference theory, such as propensity score matching.

“Our results therefore suggest a causation rather than a mere correlation,” she said.

However, Alleva noted that since the mechanisms through which dysmenorrhea increases cardiovascular risk are still unknown, they do not know at this time a good strategy to decrease risk.

However, there are ways to understand what your risk might be.

Modifying lifestyle habits may help reduce their risk of cardiovascular disease and ease symptoms of PCOS. This can include exercising more, prioritizing sleep, and eating well-balanced meals.

“Currently, there are no approved medications specifically indicated to treat the underlying condition of PCOS, only medications that address symptoms associated with the disease,” Mirkin said.

He explained that lab tests can help people better understand their own risk of cardiovascular disease. It’s also important to monitor blood pressure and weight.

“However, oftentimes these lifestyle changes may not be enough for women to see a significant difference,” Mirkin said. “Women should talk to their doctor about what tools are available for treatment.”