What People With PCOS, Painful Periods Should Know About Their Heart Disease Risk

Women with certain menstruation disorders may have a higher risk of heart disease, according to new research.

Having a period can come with cramps, nausea, and other uncomfortable symptoms. But for some women, additional menstruation disorders bring additional discomforts.

Two of the more common menstruation disorders are PCOS and dysmenorrhea.

Polycystic ovary syndrome (PCOS) is a hormonal condition that affects female reproductive organs and can cause missed or irregular menstrual periods, excess hair growth, severe acne, infertility, and weight gain. It affects between 6-12% of women in the United States.

Dysmenorrhea—incredibly painful period cramps—is typically caused by an underlying health condition, such as uterine fibroids, tumors, endometriosis, pelvic inflammatory disease, adenomyosis, or uterine polyps.

The rate of dysmenorrhea varies between 16% and 91% in people with ovaries, with severe pain affecting roughly 2% to 29%.

Both diseases are most commonly found in younger people. 

New, preliminary research found that women with PCOS or dysmenorrhea tend to have a higher risk of cardiovascular disease.

The findings from each study were presented earlier this month at the American Heart Association’s Scientific Sessions 2023.

“Menstruation-related factors, in general, are important to look at since they are specific to the young female population, which is the population for which current risk prediction models perform worse,” Eugenia Alleva, MD, MS, an author of one of the studies, told Health.

Here’s what you need to know about how these menstrual disorders are linked to cardiovascular health, and how to ease symptoms associated with the disorders.

The first of the new studies looked at 30,500 people with ovaries with dysmenorrhea and 25,300 without ovaries to understand how the condition impacted the prevalence of heart disease.

“Looking at dysmenorrhea, in particular, is important given that dysmenorrhea stands as the most prevalent menstrual complaint and is associated with heightened stress and disruption of the autonomic nervous system influencing heart and vessel function, as well as an increase in certain molecules related to inflammation,” said Alleva.

The research team analyzed participants who were diagnosed with heart disease before age 50, as well as those with various heart disease conditions like heart attacks, and chronic heart disease, and participants who had abnormal menstrual conditions, like missed menstrual cycles, heavy bleeding, and endometritis. 

They found that participants with dysmenorrhea were more likely to have chronic or ongoing ischemic heart disease—a condition where the heart gets less blood and oxygen, due to narrow blood vessels.

Alleva explained that the study’s focus was identifying cardiovascular risk, not necessarily understanding how the condition may be causing that risk.

“However, our hypothesis is that heightened stress and disruption of the autonomic nervous system influencing heart and vessel function, as well as increase in certain molecules related to inflammation, might be a responsible mechanism,” she said.

She explained that this is because inflammation and stress are linked with increased cardiovascular risk, with stress particularly noted for its relevance in ischemic heart disease among young women.

The second study looked at nearly 17,000 young people with ovaries and found that the risk of high blood pressure was 30% higher for participants with PCOS than those without the condition.

Researchers also found that PCOS was associated with a 1.3-fold higher risk of having a hypertensive blood pressure reading of greater than 130/80 mm HG.

“PCOS is one of the most common conditions in reproductive-aged women, and it is more than just a gynecological disorder,” Sebastian Mirkin, MD, an obstetrician-gynecologist, reproductive endocrinologist, and women’s health clinical research lead at Organon, told Health.

“It is a metabolic condition where women experience increased androgen levels that induce insulin resistance,” said Mirkin, who was not part of either new study. “Increased androgen levels are what prevent a woman’s ovaries from releasing eggs, causing irregular menstrual cycles, and infertility.”

Mirkin noted that people with PCOS are at higher risk of obesity, hypertension, and other conditions, which can in turn contribute to increased cardiovascular disease risk.

“Women can experience different types of PCOS, but the most common is metabolic disease, which can cause hypertriglyceridemia, hypertension, and obesity, as well as increased risk of type 2 diabetes,” he said.

So, why do these menstrual disorders seem to be linked to cardiovascular health? 

“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.”