Key takeaways:
- Women with endometriosis showed significantly reduced blood pressure responses to stressors, indicating altered autonomic nervous system function.
- Experimental testing revealed consistently lower cardiovascular reactions in patients with endometriosis compared with controls.
- Findings contradict prior assumptions that endometriosis would correlate with elevated blood pressure due to higher cardiometabolic risks.
- The results support viewing endometriosis as a multisystem disease rather than solely a gynecologic condition.
- Experts emphasize systematic surgical evaluation and appropriate platform selection to optimize management of complex endometriosis cases.
The function of the autonomic nervous system is impacted by endometriosis, according to a recent study published in Hypertension.1
A significant reduction in blood pressure response was reported in women with endometriosis exposed to exercise or submerging their hand in cold water vs those without endometriosis. According to investigators, this may have significant implications for diagnosing and managing endometriosis.
“Medical science understands very little about endometriosis, so in order to diagnose and treat the disease effectively, we need to grasp the full scope of the disease and what it is doing to women throughout their bodies,” said Auni Williams, postdoctoral fellow at Penn State.
Study population and experimental design
There were 21 women included in the final analysis, 12 of whom had endometriosis and 9 did not. These patients underwent 2 experiments, the first of which measured blood pressure after placing their right hand in water at a temperature between 4 and 8 degrees Celsius for 3 minutes.
An additional 15 minutes of blood pressure measurement was performed once participants removed their hand from the water. In the second experiment, both blood pressure and heart rate were continuously measured while women squeezed a tool to measure grip with maximum force, rested, then squeezed again with 30% of maximum hand strength for 2 minutes.
The blood cuff was inflated around patients’ arms just before the 2 minutes ended. An additional 5 minutes of blood pressure measurement was performed following cuff deflation.
Endometriosis as a multisystem disease
Traditionally, endometriosis, which impacts 1 in 10 women, has been treated solely as a gynecological condition. It is commonly treated through removal of lesions, but while this method relieves pain, it does not manage other symptoms such as the decrease in blood pressure.
Previous data has highlighted increased risks of diabetes, artery disease, and high cholesterol in women with endometriosis, leading investigators to suspect endometriosis patients would display elevated blood pressure. However, the opposite results were observed, with a lower increase in blood pressure following both experiments among women with vs without endometriosis.
According to investigators, this indicates a lower neurological response to stress in endometriosis patients. This may be a source of lightheadedness often reported in this population.
“Compared to the crippling pain that endometriosis can cause, the lightheadedness associated with a decreased blood-pressure response is trivial,” said Williams. “What matters here is the evidence that the autonomic nervous system functions differently in women with endometriosis.”
Surgical management strategies
This data highlights the importance of managing endometriosis in patients. Surgical management methods were discussed at the 2025 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting by Trina Mansour, MD, a gynecologic surgeon from the Phoenix VA Healthcare System.2
During the presentation, Mansour highlighted the importance of a systematic approach for endometriosis surgery. This should begin with a comprehensive survey of the upper abdomen, working clockwise to ensure atypical lesions are not overlooked. According to Mansour, all suspicious lesions should be removed to increase confidence in identifying those that are atypical.
Mansour also discussed choosing the surgical platform to use based on context. As laparoscopic surgery is more cost-effective, it may be the better option in certain cases. However, a multidisciplinary approach is needed in more complex cases, such as those involving the bowel, kidney, or ureter.
“It really depends on the extent of the disease, what platform is available, and surgeon expertise,” said Mansour. “In the right hands, both robotic and laparoscopic surgery provide patients with relief of their symptoms.”
