Altered Blood Pressure Reflexes in Women With Endometriosis

Endometriosis is a risk factor for cardiovascular disease. COX (Cyclooxygenase) is upregulated in endometriotic lesions, potentially exaggerating pressor reflexes, a major risk factor for adverse cardiovascular events. The purpose of this study was to determine whether women with endometriosis demonstrate exaggerated pressor responses. We hypothesized that women with endometriosis would show exaggerated blood pressure (BP) compared with healthy women during handgrip exercise and cold pressor testing (CPT).

In a single-blind, randomized, crossover design, women with (Endo; n=11) and without (healthy control [HC]; n=9) endometriosis underwent a CPT and handgrip with postexercise ischemia (HG+PEI) following aspirin (a nonselective COX inhibitor; 650 mg) or placebo. BP was continuously monitored during baseline (5 minutes) and hand submersion (3 minutes; 4-8 °C) during CPT, and during baseline (5 minutes), 30% maximal voluntary contraction handgrip (2 minutes), and postexercise ischemia (3 minutes) for HG+PEI.

Women with endometriosis demonstrated attenuated pressor responses to CPT (change in mean arterial pressure [∆MAP] Endo 21±16 versus HC 34±20 mm Hg; P<0.01) and HG+PEI (HG+PEI: ΔMAP Endo=12±13/13±10 mm Hg, HC=24±14/20±8 mm Hg; P<0.01). There was no effect of aspirin on blood pressure response to either CPT or HG+PEI.

Compared with age-matched HC, women with endometriosis demonstrate lower increases in blood pressure in response to cold exposure and exercise. Aspirin, a COX inhibitor, had no impact on these responses. Collectively, these results suggest that women with endometriosis demonstrate altered central integration and attenuated sympathetic outflow or end-organ responsiveness.