Endometriosis and cholesterol: what the research shows

If you live with endometriosis, you already know how much it can affect your day to day life. Pain, fatigue, and fertility worries often take centre stage. So it might come as a surprise that researchers are now looking at how endometriosis may connect with cholesterol and heart health too. Here is what the evidence shows so far.

What has the research found?

The biggest study on this topic followed more than 116,000 nurses in the United States for 20 years. Women with endometriosis were around 25% more likely to develop high cholesterol than women without it.¹ Interestingly, the connection seemed to work in both directions. Women with high cholesterol were also a little more likely to be diagnosed with endometriosis later on. The link was strongest in women aged 40 and under.

The same group of women also had a higher risk of heart disease over time.² A large study from Denmark, including more than 60,000 women with endometriosis, found a similar pattern.³ It is worth knowing that the actual difference in risk was small. This is about awareness, not alarm.

Why might the two be connected?

Researchers are still piecing this together, but there are a few ideas.

Inflammation. Endometriosis is an inflammatory condition. Ongoing inflammation also plays a role in heart health, so the two may share some common ground.⁴

Treatment and hormones. Oestrogen helps keep cholesterol in a healthy range. When the ovaries are removed as part of treatment, oestrogen drops earlier than it naturally would. In the nurses study, treatment like this explained almost half of the link with high cholesterol.¹

Shared pathways. Some genetic research suggests certain blood fats, such as lower HDL (good) cholesterol and higher triglycerides, might play a role in endometriosis developing in the first place.⁵

What we are still learning

Most of these studies show a connection, not a cause. They do not prove that endometriosis leads to high cholesterol. Smaller studies measuring blood fats directly have also had mixed results.⁴ What we do know is that supporting heart health through nutrition is beneficial regardless, and for women with endometriosis, it can be a practical and worthwhile part of long term care.

Endometriosis does not mean high cholesterol is inevitable. It is a good reason to include cholesterol checks in routine care, particularly after surgery involving the ovaries.

Small steps that support your heart

These are well established habits for healthy cholesterol levels. The focus is on adding nourishing foods, not cutting things out.

• Chat with your GP about checking your cholesterol as part of your regular care.
• Enjoy foods rich in soluble fibre, like oats, lentils, chickpeas, barley, and fruit.
• Cook with olive oil and add avocado, nuts, and seeds to meals and snacks.
• Include oily fish such as salmon, sardines, or trout a couple of times a week.
• Fill your plate with colourful vegetables, wholegrains, and plant proteins.
• Move your body in ways that feel good, and be kind to yourself on flare days.

Many of these foods also overlap with anti inflammatory eating patterns, which can support overall symptom management in endometriosis.

Endometriosis may be linked with a higher chance of high cholesterol and heart disease, particularly at younger ages and after surgery affecting the ovaries. The research is still growing. In the meantime, regular check ups and nourishing, heart supportive meals are practical and caring ways to look after your long term health.

Want support with endometriosis and nutrition?

You do not have to figure this out on your own. At Nula Nutrition, I offer 1:1 women's health dietitian consultations with support for endometriosis, symptoms, and long term health. Available in Calgary and online across Alberta, including Canmore, Banff, Edmonton, and Cochrane.

Ready to get personalised nutrition support?

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Please note: This post is intended for general educational purposes only and does not constitute personalised medical or dietetic advice. Please speak with your healthcare team about your individual heart health and cholesterol management.

Written by Madison Hows RD APD

References

1. Mu F, et al. Association between endometriosis and hypercholesterolemia or hypertension. Hypertension. 2017;70(1):59–65. PMID: 28559401

2. Mu F, et al. Endometriosis and risk of coronary heart disease. Circ Cardiovasc Qual Outcomes. 2016;9(3). PMID: 27025928

3. Havers-Borgersen E, et al. Endometriosis and long-term cardiovascular risk: a nationwide Danish study. Eur Heart J. 2024;45(44). PMID: 39219447

4. Marchandot B, et al. Endometriosis and cardiovascular disease. Eur Heart J Open. 2022;2(1):oeac001

5. Yan J, et al. Bidirectional causality between the levels of blood lipids and endometriosis: a two-sample Mendelian randomization study. BMC Womens Health. 2024. PMID: 38965508