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

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.