Heart disease has long been the leading cause of death for women in the United States, but new research suggests that uterine fibroids, which many may not even realize they have, may put them at significantly greater risk.
A large 10-year study found that women with leiomyomas have an 81% higher long-term risk heart disease than those who have no general condition. Women with fibroids—usually benign tumors that can form on or in the uterus—also had a higher individual risk of cerebrovascular, coronary and peripheral artery disease ten years after diagnosis.
The study involved more than 2.7 million U.S. women and was led by scientists at the Perelman School of Medicine at the University of Pennsylvania. It was published on Wednesday in the magazine Journal of the American Heart Association.
“We hope our study adds to this growing evidence that reproductive health can provide important insights into cardiovascular health,” said lead author Julia DiTosto, a doctoral student in epidemiology at the University of Pennsylvania. “More information is needed about exactly how these conditions are biologically linked, as well as identifying potential strategies for preventing cardiovascular disease.”
Fibroids are severely underfunded field of women's health research. In 2024, the National Institutes of Health allocated $17 million for fibroid research, up from $14 million in 2023. By comparison, National Institutes of Health data shows that $28 million went to endometriosis, $59 million to menopause, and $740 million to breast cancer. Previous studies of fibroids and heart disease have been “sparse and inconclusive,” DiTosto and her co-authors wrote.
In this new study, researchers examined a healthcare database containing patient records from 2000 to 2022. About 450,000 women have been diagnosed with fibroids, but more than 2.2 million have not. The average age of the patients was 41 years.
The researchers calculated the patients' risk of cardiovascular disease after one, three, five and 10 years. For each specific condition studied, including stroke and heart attack – and also general heart diseasewomen with fibroids had a higher risk at each follow-up period.
Women with fibroids had an increased risk of cardiovascular disease across all age groups, races, and ethnicities. However, in women under 40 years of age, the association between uterine fibroids and cardiovascular disease was stronger, and the risk was 251% higher after 10 years. This was a particularly surprising finding given that older age is a risk factor for cardiovascular disease, DiTosto said.
Fibroids are known to disproportionately affect black womenwho are often diagnosed at a younger age, suffer more severe symptoms, and have larger or more numerous tumors. However, the study found that the risk of heart disease was lowest among black women with fibroids. The risk was highest and most uncertain among Asian women aged one, three and five years. After 10 years, the risk was highest among Hispanic women.
“Uterine fibroid is not just a gynecologic health issue,” DiTosto said. “They can also influence wider conditions, so it’s important to think about health holistically.”
How fibroids can increase your risk of heart disease
Fibroids are extremely common, affecting approximately 26 million women of childbearing age in the United States. According to the Federal Women's Health Administration, 20% to 80% of women will develop fibroids by age 50.
A woman can have more than one fibroid at the same time and in different places in the uterus. The growth can be the size of a seed or the size of a watermelon, making the woman appear pregnant. Treatment varies from minimally invasive proceduressuch as radiofrequency ablation, which uses heat to damage tumor tissue, up to hysterectomyNew fibroids can grow even after old ones are surgically removed.
In most cases, women have no symptoms and don't know they have fibroids until they have a pelvic exam or imaging. Dr. John Petrozza, co-director of the Integrated Fibroids Program at Massachusetts General Hospital, said women who have fibroid symptoms I find them often exhausting.
“They cost a lot of healthcare resources to treat the symptoms associated with fibroids, which include heavy menstrual bleeding, iron deficiency anemia, pelvic pressure, bowel symptoms, bladder symptoms, infertility,” said Petrozza, who was not involved in the study.
Fibroids are powered by two hormones produced by women of reproductive age. estrogen and progesterone — which may be key to their connection to cardiovascular disease, Petrozza said.
“These hormones can cause other things like smooth muscle cell proliferation, fibrosis, calcification, which affects your vascular system,” he said. “And then if you start having heavy periods because of the fibroids and you start to suffer from iron deficiency anemia, that will have a stress-like effect on your blood pressure.”
Such symptoms can cause stress throughout the body, which in turn can cause biological changes, including inflammation, he said.
Fibroids are often found in obese peoplewho may have other medical conditions that increase the risk of cardiovascular disease.
“There is a potential cause and effect that needs to be studied a little more, but in my opinion, that's how I envision this connection,” Petrozza said, later adding, “You get a chain reaction that can cause atherosclerotic cardiovascular disease, which is associated with heart attacks and strokes.”
Who is at risk for developing uterine fibroids?
The observational nature of the study was one of its main limitations, DiTosto said. She and her team analyzed patient records from Optum's Clinformatics Data Mart, which was designed for insurance billing, not clinical research.
While the database allowed the researchers to study a large sample size and long-term outcomes, it did not take into account more detailed information such as patient size and the number and location of fibroids, “which may provide more information about the mechanisms underlying how fibroids and cardiovascular disease may be linked,” DiTosto said.
The study also did not look at the possible impact of fibroid removal on the risk of cardiovascular disease.
Additionally, the database included only privately insured patients who may have had access to better fibroid diagnosis and treatment than their uninsured counterparts.
Women with a family history of tumors are more likely to suffer from them. Other risk factors include older age (as a result of menopause), obesity, high blood pressure, vitamin D deficiency, alcohol consumption, a diet high in red meat, not being pregnant, and starting menstruation at an early age.
Petrozza says fibroids are often asymptomatic, but women should be careful not to ignore warning signs.
“If you notice any changes in your menstrual cycle, if you notice an increase in belly volume, if you just don't feel well in your pelvic area, if you're going to the bathroom more often, if you're having difficulty conceiving, these are subtle signs of uterine fibroids,” he said. “This should be a reason for you to report this to your primary care physician or your gynecologist.”
