UArizona Health Sciences Study Seeks to Understand Relationship among Endometriosis, Infertility and Stroke in Women

TUCSON, Ariz. — Endometriosis is a chronic, often painful, gynecological disorder affecting 10% to 15% of U.S. women of childbearing age in which tissue normally lining the uterus grows outside the uterus, causing higher incidence of miscarriages and infertility and greater risk of stroke.

In addition to increased stroke risk, women with endometriosis – a painful gynecological condition – are at twice the risk of infertility. Endometriosis diagnoses represent 20% to 50% of all infertility diagnoses.Leslie V. Farland, ScD, an assistant professor in the Department of Epidemiology and Biostatistics at the Mel and Enid Zuckerman College of Public Health at the University of Arizona Health Sciences, has been awarded federal funding to study the association among endometriosis infertility and risk of stroke.

Dr. Farland, who is in the college’s Division of Epidemiology, will collaborate with Melanie L. Bell, PhD, a professor in the Division of Biostatistics, as well as colleagues at Michigan State University and Harvard Medical School. Their study is funded by a $442,000, two-year grant from the National Institutes of Health (NIH) that builds on prior endometriosis research supported by an Endometriosis Foundation of America award Dr. Farland received in 2018. She collaborated with public health doctoral candidate William Degnan on that project.

Leslie V. Farland, ScDA paper co-authored by Dr. Farland, and published in July in a European journal, concluded exposure to breastfeeding early in life, and exposure to secondhand smoke in childhood, were among factors related to endometriosis risk. Another paper, that appears in the June issue of the American Journal of Obstetrics & Gynecology, noted a connection between endometriosis and several adverse pregnancy outcomes, pointing to future research for potential biological pathways underlying these relationships to inform screening or preventive interventions.

About three-quarters of endometriosis sufferers experience pelvic pain during their menstrual cycle. Others also suffer from pain in the lower abdomen, pain during or after sex, spotting or bleeding between periods, digestive and gastrointestinal issues, as well as fatigue.

Melanie L. Bell, PhD

Dr. Farland said women with endometriosis are at twice the risk of infertility and endometriosis diagnoses represent 20% to 50% of all infertility diagnoses. Recent research also suggests women with endometriosis and women with infertility may be at an increased risk of cardiovascular and other chronic diseases later in life.

Despite a disproportionate burden in women, stroke is particularly understudied in relation to endometriosis and infertility, she points out. Moreover, very few studies have investigated the role of endometriosis in the presence and absence of infertility. Therefore, this study provides an opportunity to investigate endometriosis and infertility as a marker of stroke risk using data from more than 116,000 women in the Nurses’ Health Study II. These women were enrolled in 1989 and followed every two years to collect detailed information on a variety of health and lifestyle factors. A paper based on that research found that women who experienced endometriosis also were:

  • 1.35 times more likely to need surgery or stenting to open blocked arteries;
  • 1.52 times more likely to have a heart attack; and
  • 1.91 times more likely to develop angina (chest pain).

This research represents the first step toward understanding the association among endometriosis, infertility and stroke burden and the mechanisms underlying these associations. The research team seeks to provide insights that shape future research into etiology, prevention, management and treatment for women with endometriosis.

Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the NIH under Award No. R21HD099623. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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A version of this article appeared originally on the UArizona Mel and Enid Zuckerman College of Public Health website.

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About the University of Arizona Mel and Enid Zuckerman College of Public Health
Established in 2000, the Mel and Enid Zuckerman College of Public Health at the University of Arizona Health Sciences is the first nationally accredited college of public health in the Southwest. Today the college remains the only accredited college of public health in the state of Arizona, with campuses in Tucson and Phoenix. The college enrolls more than 1,100 students per year across degree programs at the bachelor's degree, master's degree and doctoral levels. Through research, education and community engagement, the UA Zuckerman College of Public Health continues to find solutions to public health problems in Arizona, the Southwest and globally. For more information: (Follow us: Facebook | Twitter).

About the University of Arizona Health Sciences
The University of Arizona Health Sciences is the statewide leader in biomedical research and health professions training. UArizona Health Sciences includes the Colleges of Medicine (Tucson and Phoenix), Nursing, Pharmacy, and the Mel and Enid Zuckerman College of Public Health, with main campus locations in Tucson and the Phoenix Biomedical Campus in downtown Phoenix. From these vantage points, Health Sciences reaches across the state of Arizona, the greater Southwest and around the world to provide next-generation education, research and outreach. A major economic engine, Health Sciences employs nearly 5,000 people, has approximately 4,000 students and 900 faculty members, and garners $200 million in research grants and contracts annually. For more information: (Follow us: Facebook | Twitter | YouTube | LinkedIn | Instagram).