Researchers have found that women with endometriosis, especially those age 40 or younger, may have a higher risk of heart disease. The research paper, titled “Endometriosis and Risk of Coronary Heart Disease,” was published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

The team reviewed medical data of 116,430 women enrolled in the Nurses’ Health Study II, taking into account alternative therapies for the treatment of the disease, including oral contraceptive and hormone replacement therapy. By the end of follow-up, endometriosis was diagnosed by surgical examination in 11,903 of all examined women.

During the 20-year follow-up, scientists found that women with endometriosis were 1.35 times more likely to receive coronary artery bypass graft surgery or coronary angioplasty procedure/stent, a higher risk (1.52) of myocardial infarction and 1.91 times more likely to develop chest pain (angina). Relative risk of coronary heart disease was highest among women ages 40 years or younger. Compared to patients without endometriosis in the same age group, those suffering from the condition were three times more likely to have a heart attack, chest pain, or need treatment for blocked arteries.

Researchers also noted that surgical treatment for endometriosis could be involved in this higher risk for heart disease: Removing the uterus or ovaries (surgically-induced menopause) may increase the risk for heart disease, which may be more evident at younger ages. Moreover, the higher frequency of these specific surgeries and the earlier the age at surgery after endometriosis diagnosis can partially explain the association between endometriosis and coronary heart disease.

“It is important for women with endometriosis — even young women — to adopt heart-healthy lifestyle habits, be screened by their doctors for heart disease, and be familiar with symptoms, because heart disease remains the primary cause of death in women,” senior study author Stacey A. Missmer, Sc.D., director of epidemiologic research in reproductive medicine at Brigham and Women’s Hospital in Boston, said in a news release.