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Premenstrual disorders are associated with a higher risk of developing cardiovascular disease, a large, long-term study has found.
New research analyzing patient health data from more than 3 million women in Sweden over a 20-year period found that those who were diagnosed with premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) had an 11% higher risk of developing cardiovascular disease at some point, compared to women who did not have a diagnosis.
Younger women who experienced a premenstrual disorder before age 25 had an even stronger risk of developing heart disease, 24%.
Heart disease is the leading cause of death in women in the U.S.
“It’s another reminder of taking care of your cardiovascular health when you’re young and not waiting until you’re in your 50s or later,” Elizabeth Bertone-Johnson said, study co-author and professor of epidemiology at the University of Massachusetts-Amherst.
In order to be diagnosed with PMS or the more intense PMDD, symptoms such as mood swings, fatigue, cramping and food cravings need to be “bad enough” to be rated as “moderate” or “severe,” or have a significant impact on a patient’s ability to function, Bertone-Johnson said.
The researchers analyzed subtypes of cardiovascular disease, including heart failure, arrhythmias and irregular heartbeat. An arrhythmia occurs when the heart’s electrical signals misfire, making the heart beat too quickly or too slowly. Arrhythmias and ischemic heart disease, damage caused by plaque which has built up in the coronary arteries, showed the strongest associations with PMS and PMDD.
Although the research did not study the possible reasons behind the link, Bertone-Johnson and other experts believe that premenstrual disorders might indicate other underlying physiological conditions.
“Eventually it will show up as cardiovascular disease, but before that, it shows up in premenstrual symptoms,” Bertone-Johnson said.
These conditions can include inflammation and alteration of the renin-angiotensin-aldosterone system — a hormonal system that regulates blood pressure, Dr. Nieka Goldberg, a cardiologist who specializes in women’s health at NYU Langone, said. These inflammatory changes can lead to an increased buildup of plaque around the heart’s arteries — increasing the risk of heart disease. Goldberg was not involved in the new research.
Even accounting for other cardiovascular risk factors such as smoking, weight, medication usage and some pre-existing conditions, women who had been diagnosed with a premenstrual disorder were more likely to develop heart problems.
Researchers in Sweden also analyzed pairs of sisters as a way of accounting for genetic and environmental factors.
There are limitations to the research. Bertone-Johnson said they looked only at women who had a clinical diagnosis of a premenstrual disorder and, because the population was based in Sweden, the patients were likely mostly white.
Dr. Priya Jaisinghani, an endocrinologist at NYU Langone, thinks there should be more focus on women’s risk factors for heart disease, which can include reproductive, hormonal and metabolic conditions.
This study as well as others suggest a link between PMS and/or PMDD and hypertension, or high blood pressure. Still, high blood pressure is often underdiagnosed in women, according to the Office of Women’s Health.
Goldberg said that one of the most important implications of this study is how it may pave the way for diagnosis of cardiovascular disease in younger patients.
“This is a great step to early identification of women at risk for heart disease earlier in life,” she said. “Although the mechanism for heart disease risk in premenstrual disorders will need further study, it is important for doctors to get a complete menstrual history, including the presence of PMD in their patients.”
