Longitudinal measurements of NO-mediated vasodilation and physical activity over 1 yr following endometriosis excision surgery: a passive experiment

Abstract

Women with endometriosis are at increased risk of cardiovascular disease and demonstrate endothelial dysfunction. The gold standard for diagnosis of endometriosis is through operative laparoscopy with surgical excision and histopathologic identification of endometrial-type glands and stroma. Symptoms of endometriosis are often immediately improved or resolved following excision surgery, but the cardiovascular impact of excision surgery is underappreciated. This passive experiment reports the longitudinal adaptations of the macrovascular and cutaneous microvascular endothelium in a single patient following surgical excision of endometriosis. The patient participated in multiple vascular research studies targeting nitric oxide-mediated vasodilation over the course of the succeeding 13 mo postsurgery. We show no nitric oxide (NO)-mediated vasodilation in the microvascular endothelium [-34 arbitrary units (AU)] and no flow-mediated dilation (FMD) in the brachial conduit artery (-0.06%) 1-mo postsurgery, with a recovery seeming to occur ∼8 mo postsurgery (178 AU, 3.69% FMD) that does not remain ∼13 mo postsurgery (3 AU, 0.43%). These values occur in tandem with reported exercise before testing [1,746 to 3,759 to 1,954 metabolic equivalent (MET) min/wk, respectively]. The results of these studies, placebo and baseline visits, are presented here. These findings suggest that microvascular endothelial function in an otherwise healthy young woman with endometriosis is not necessarily recovered following excision surgery, but may be dramatically improved with resistance exercise. Our data may lend insight into the progression of vascular dysfunction in this disease and the role of surgical versus lifestyle intervention in this realm.NEW & NOTEWORTHY This passive experiment demonstrates that vascular endothelial function is not recovered following endometriosis surgery but may be improved with resistance exercise.

Keywords: endometriosis; flow-mediated dilation; microdialysis; microvascular function; nitric oxide.

Figure 1.

Timeline of events.

Figure 2.

Microvascular endothelial function as characterized by NO-mediated vasodilation in the cutaneous microvasculature. The shaded region is an artificial redrawing of reference values measured in similarly-aged healthy individuals (Content et al., 2024; Greaney et al., 2022).

Figure 3.

Macrovascular endothelial function as characterized by brachial artery flow-mediated dilation (FMD%). The shaded region is an artificial redrawing of reference values measured in similarly-aged healthy individuals (Eagan et al. 2021)

Figure 4.

Metabolic equivalent (MET)-minutes the participant performed in the four 7-day periods preceding her experiment visits as determined from International Physical Activity Questionnaire (IPAQ) short form questionnaires and documented exercise bouts. Panel A shows total MET-min/wk; panel B shows MET-min/wk separated into those deriving from high intensity resistance training and walking.