Body image, self-compassion, and sexual distress in individuals living with endometriosis

Endo Belly: A Mixed Methods Exploration of Body Image, Disordered Eating, and Psychopathology in Endometriosis

OBJECTIVE

There is increasing interest in the impact of endometriosis on body image, however, there is minimal understanding of the presence and nature of disordered eating. As body image dissatisfaction is elevated in this population and a risk factor for eating disorders, it is likely that disordered eating is also elevated which has important clinical implications for prevention and intervention. The current study aimed to explore the relationships between endometriosis, body image flexibility, eating disorder psychopathology, negative affect, and self-criticism using a mixed-methods design.

METHOD

People (n = 179) with endometriosis, over the age of 18 years, and living in Australia were recruited using social media. Quantitative measures included the Body Image Acceptance and Action Questionnaire, Eating Disorder Examination Questionnaire 7-item Short Form, Depression Anxiety and Stress Scales, and the Inadequate Self subscale of the Forms of Self-Criticising/Attacking and Self-Reassuring Scale. Participants were also asked two open-ended questions that enabled reflexive thematic analysis of the impact endometriosis has on body image and eating, using Braun and Clarke's six phase process.

RESULTS

Participants were mostly female, heterosexual, White, and had a mean age of 30. The sample demonstrated high levels of eating disorder psychopathology, negative affect, and self-criticism, and low body image flexibility. Thematic analysis yielded three main themes, that were highly consistent with quantitative findings: Body disappointment, Food as an enemy, and Stolen identity and joy.

CONCLUSIONS

This study highlights the need for prevention and intervention efforts focused on reducing eating disorder psychopathology and body image concerns experienced by individuals with endometriosis.

Health-related decision-making experiences of people with endometriosis: a qualitative analysis

Objective: Endometriosis is an incurable inflammatory condition, characterised by chronic pelvic pain, among other symptoms. Optimal symptom management is dependent on an individual's preferences, underscoring the need for person-centred care and shared decision-making. Yet research on decisional support needs of people with endometriosis (PWE) is sparse. This qualitative study aimed to explore decisional processes and decision support needs among PWE regarding endometriosis management. Methods and Measures: Australian adults (N = 41) diagnosed with endometriosis were recruited from support communities to participate in focus groups. Open-ended questions prompted discussion about perceived challenges and facilitators of treatment decision-making. Multiple coders thematically analysed the transcribed qualitative data using the template approach. Results: Four themes were identified: (1) Challenges of accessing pertinent, quality information (sub-themes 1a: Inadequate information from healthcare professionals and 1b: Navigating external information sources); (2) Feeling empowered to self-advocate; (3) Balancing costs and benefits (sub-themes 3a: Financial considerations; and 3b: Balancing family needs); and, (4) Emotional toll of decision-making. Novel findings included emphasis by PWE on family needs when making decisions, and reports that decision-making eroded their resilience. Conclusion: Findings highlight difficulties experienced by PWE regarding endometriosis management, indicating a comprehensive decision support resource, such as a patient decision aid, is warranted.

Mental freedom and body acceptance by others as correlates of embodied well-being in women with polycystic ovary syndrome in Australia

Polycystic ovary syndrome (PCOS) is a common reproductive-endocrinological-metabolic condition in women, causing bodies to diverge from cis-heteronormative feminine expectations. Greater body image concerns have been identified among women with PCOS, but further research is needed to identify drivers and mitigating factors. The ability to inhabit the body positively may be one such mitigating factor, and the developmental theory of embodiment is a novel framework allowing exploration of an integrated range of protective (and risk) sociocultural factors that may contribute to embodied well-being. This cross-sectional survey study therefore examined relationships among embodied well-being, severity of PCOS symptoms, body mass index (BMI), mental freedom (exposure to a social environment that facilitates an internalised critical stance towards oppressive social discourses, including femininity discourses on appearance and comportment), and perceived body acceptance by others in a sample of 140 women with PCOS, 18 years and over, living in Australia. Results of hierarchical multiple regression demonstrated that BMI and PCOS severity were negatively related to embodied well-being, but that when mental freedom and perceived body acceptance by others were added to the model, only PCOS severity, mental freedom, and body acceptance by others were significantly related to embodied well-being. Neither mental freedom nor body acceptance by others moderated the relationship between PCOS severity and BMI and embodied well-being. Results support BMI and PCOS severity as drivers of, and mental freedom and body acceptance by others as protective factors for, embodied well-being in women with PCOS, and have implications for interventions to support embodied well-being.

Investigating the link between severity of dyspareunia and female sexual distress among a group of women with endometriosis: the mediating role of body functionality appreciation

BACKGROUND

While existing studies have predominantly focused on negative body image and its potential link to female sexual distress in women with endometriosis, no studies have investigated how positive body image (ie, body functionality appreciation) mediates the association between dyspareunia severity and sexual distress in this population.

AIM

This study aimed to investigate the mediating role of body functionality appreciation in the relationship between severity of dyspareunia and sexual distress in women living with endometriosis.

METHODS

A total of 232 women with endometriosis (M = 35 years) took part in the study. Participants completed an anonymous questionnaire evaluating dyspareunia severity, functionality appreciation, female sexual distress, sociodemographic factors, and endometriosis-related clinical information. All participants were administered the following questionnaires: numerical rating scale, body functionality appreciation, female sexual distress scale.

OUTCOMES

Using a mediation model, the study analyzed both the direct and indirect effects of dyspareunia severity on sexual distress, with functionality appreciation as a mediator.

RESULTS

The findings suggest that the severity of dyspareunia significantly contributes to sexual distress both directly and indirectly, by diminishing the appreciation for body functionality.

CLINICAL IMPLICATIONS

Clinicians should not only focus on the severity of dyspareunia when evaluating sexual distress in women; instead, they should also acknowledge the protective role of positive body image. Integrated treatments that promote body functionality appreciation could enhance treatment outcomes.

STRENGTHS AND LIMITATIONS

The study is the first to examine the mediating role of body functionality appreciation in the relationship between dyspareunia severity and sexual distress in a sample of women with endometriosis; however, the assessment was cross-sectional and did not encompass other factors that may influence the connection between dyspareunia severity and sexual distress.

CONCLUSION

These findings, in addition to advancing theoretical understanding of the role of positive body image in women with dyspareunia, may be valuable in guiding the design of interventions aimed at reducing sexual distress in women with high levels of dyspareunia severity.

"No doctor ever asked me…so I thought it wasn't a valid concern": endometriosis patients' perspectives of barriers and facilitators to sexual health communication in general practice

BACKGROUND

Sexual health communication between general practitioners (GPs) and individuals with chronic diseases is well documented as an important component of sexual well-being. However, a notable gap exists in understanding factors that contribute to sexual health communication in the endometriosis context. Endometriosis-related research has focused on the assessment of sexual functioning and its role in influencing health-related quality of life, with a limited understanding of the management of sexual well-being in primary healthcare settings.

AIM

To explore how individuals with endometriosis perceive their experiences of sexual health communication with GPs to understand the barriers and facilitators of this communication in general practice.

METHODS

This study formed part of a larger online quantitative survey measuring psychological and sexual well-being in individuals with endometriosis. In total 141 participants provided responses via open-ended unlimited free-text questions focused on their experiences of sexual health communication with GPs, including their perspectives on barriers and facilitators.

RESULTS

Four overarching themes regarding barriers to sexual health communication were identified through thematic template analysis: (1) systemic factors; (2) practitioner factors; (3) patient factors; and (4) interpersonal factors. Facilitators mirrored strategies to address these barriers. Additionally, participants offered recommendations for developing resources to improve sexual health communication.

CLINICAL IMPLICATIONS

Despite patients' interest, sexual health concerns in endometriosis are commonly overlooked in general practice due to various barriers, which individuals suggest could be addressed through comprehensive GP education and practical aids including communication tools.

STRENGTHS AND LIMITATIONS

Although the sample is large for a qualitative study, the potential selection bias-stemming from participants' high levels of sexual dysfunction and motivation to discuss sexual health with a GP-may limit the diversity of perspectives. GP perspectives were not evaluated, precluding any assessment of the accuracy of individuals' perceptions of practitioner factors.

CONCLUSIONS

Individuals with endometriosis encounter various systematic, practitioner, personal, and interpersonal factors that hinder or facilitate sexual health communication in general practice. Future research should prioritize strategies to improve sexual health communication for both GPs and patients.

Body image, illness perception, and psychological distress in women coping with polycystic ovary syndrome (PCOS)

Objective: While symptoms of polycystic ovary syndrome (PCOS) and psychological distress (PD) are directly linked, indirect effects are also apparent. The present study aims to develop an explanatory model for the effect of PCOS on women' PD and identify possible protective and risk factors. It examines the development of PD in women with PCOS and further investigates the association between body image, both positive (body appreciation) and negative (body dissatisfaction) dimensions, and PD as well as the potential mediating effect of illness perception on this association. Methods: This study comprised a total of 316 women aged 20-50 (M = 30.9, SD = 6.3) - 197 women with PCOS and 119 healthy peers-who completed questionnaires regarding demographic characteristics, anxiety (GAD-7), depression (PHQ-9), body appreciation (BAS-2), body dissatisfaction (EDI-BD), and the Brief Illness Perception Questionnaire (BIPQ). Results: Significant differences between groups were found in all measures. Body appreciation mediated the link between PCOS and PD, while body appreciation and illness perception also mediated the link between symptom level and PD among PCOS patients. Conclusion: Women with PCOS face considerable psychological strain and highlight body appreciation and illness perception as two underlying psychological mechanisms that contribute to the increased risk of distress. Interventions addressing both mechanisms may help improve PD in women with PCOS.

Exploration of Body Image in Postoperative Patients With Oral Cancer: An Exploratory Sequential Mixed Methods Study

BACKGROUND

Postoperative patients with oral cancer are deeply distressed about their body image. However, their true inner feelings and the factors influencing body image remain unclear.

AIMS

This study aims to investigate the experience of body image disturbance in patients 3 months after oral cancer surgery and analyze the influencing factors.

METHODS

This study process was divided into three steps: (1) semi-structured interviews, based on the Society Ecosystems Theory, of patients with body image disorders 3 months after oral cancer surgery, followed by theme summaries; (2) appropriate selection of scales according to the qualitative results; and (3) a cross-sectional survey to explore the factors and pathways affecting the body image of the patients.

RESULTS

Qualitative research summarized nine themes from the individual, family/employment, and societal/institutional levels, with the individual level being most commonly mentioned. Further investigation into the individual factors influencing the body image of the patients revealed that self-esteem and social alienation have a chain mediating effect on the relationship between speech handicap and body image.

CONCLUSIONS

The body image of postoperative patients with oral cancer is influenced by personal, family, and societal aspects. These study results lay the groundwork for formulating interventions to alleviate body image concerns.

A randomized feasibility trial evaluating the "My Changed Body" writing activity for people with endometriosis

OBJECTIVES

Body image disturbance is prevalent in people with endometriosis. This study aimed to explore the feasibility, acceptability and preliminary efficacy of the My Changed Body (MyCB) writing activity for body image in people with endometriosis.

DESIGN

Two-arm randomized controlled pilot and feasibility study.

METHODS

Australian adults living with endometriosis who identified as having had a negative endometriosis-related body image experience were recruited online through Endometriosis Australia. Participants completed a baseline survey capturing demographic and health data before being randomized into the MyCB or control writing conditions. Additional assessment was administered post-activity and at 1-week follow-up.

RESULTS

A total of 82 participants were recruited and randomized (Mage = 32 years, SD = 7.8). MyCB participants were less likely to complete the writing tasks compared to the control group (51% vs. 83%); MyCB completers had lower self-compassion and quality of life, and higher psychological distress, compared to those who dropped out. The MyCB activity received good satisfaction rates (47%-87%). However, there was significant drop-out in the MyCB group (n = 4 vs. 13 at 1-week follow-up). Limited-efficacy testing showed an increase in the self-compassion self-identification for the MyCB group.

CONCLUSIONS

The MyCB writing activity may be feasible for people with endometriosis. A future larger trial will benefit from several methodology changes to enhance recruitment and retention.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Registry ACTRN12622000496718; Date: 29/3/2022; retrospectively registered.

Supportive Care Needs of Young Adults With Endometriosis: An Open-Ended Online Survey and Exploration of Unmet Needs

OBJECTIVE

The aim of this study is to identify and explore the unmet needs of adolescents and young adults living with endometriosis.

DESIGN

An open-ended online survey was conducted, with questions derived from prior research looking at areas of unmet need in healthcare, career and work, financial, information, psychological, social and cultural domains.

SETTING AND POPULATION

Self-selecting 18-25 year olds with surgically diagnosed endometriosis (self-reported) currently living in Australia were included as participants.

METHODS

Invitation to participate in an open-ended online survey was shared through the social media of Australian endometriosis organisations and the Royal Women's Hospital, Melbourne. Surveys were analysed qualitatively through template analysis.

MAIN OUTCOME MEASURES

Recording of the unmet supportive care needs of this population was carried out.

RESULTS

One hundred and thirty-one respondents fit the eligibility criteria of being aged 18-25 years (median age 23 years). Most were born in Australia (94%), university-educated (54%) and lived in a metropolitan setting (69%). There was a range of unmet needs that were presented across education, work, healthcare and relationships. Group-specific challenges were identified: doctors either over- or underemphasising future fertility; disrupted sexual and romantic life due to painful sex; managing pain in the classroom and workplace where periods are taboo; and being gender-queer in gynaecological medical spaces.

CONCLUSIONS

The increasingly young age at which patients are receiving an endometriosis diagnosis precipitates a shift in patient care. The treatment decisions that are being made must be reflective of the unique needs of the adolescents who carry the burden of the disease. Clinicians are advised to be aware of and discuss needs with their patients.

PATIENT OR PUBLIC CONTRIBUTION

The nine open-ended questions in this survey were developed from data from a preliminary series of interviews with endometriosis patients in a tertiary women's healthcare centre. In asking these data-informed questions to the online endometriosis community, patients across broader sociocultural demographics and disease states (including less symptomatic endometriosis) have provided a broader understanding of their supportive care needs.

Perceived challenges in treatment decision-making for endometriosis: healthcare professional perspectives

Background

Endometriosis, a systemic chronic inflammatory condition which has no cure, has a high symptom burden that can negatively impact every facet of life. Given the absence of a gold-standard treatment, the best symptom management regimen in endometriosis is heavily reliant on a patient's values and preferences, making shared decision-making (SDM) vital. However, a comprehensive patient decision aid (PtDA) intervention that could facilitate patient decision-making and promote SDM is lacking in endometriosis, and there is little research on the decisional support needs of individuals with this condition. This qualitative study aimed to explore healthcare professional (HP) perspectives of their clients' decisional support needs when choosing treatments to manage endometriosis symptoms, with a view to evaluating the need for a PtDA.

Methods

Australian HPs identified as specialising in endometriosis care (N = 13) were invited to participate in a short interview over the Internet by phone. Questions focussed on perceived facilitators and challenges of decision-making when choosing treatments for endometriosis. Transcribed qualitative data were thematically analysed and verified by multiple coders, using the template approach.

Results

Four themes were identified: (1) Identifying and setting priorities; (2) HPs' lack of time and perceived lack of knowledge; (3) Patient-centred care and SDM, including patient capacity; and (4) Decision-making blinded by hope. This is the first known study to explore HPs' perspectives on patient decision-making challenges in endometriosis.

Discussion

Findings draw attention to the difficulties people with endometriosis experience when assessing and choosing treatments, highlighting the need for a comprehensive PtDA intervention to support this decision-making.

Factors predicting self-compassion among patients with breast cancer undergoing chemotherapy in Thailand: A cross-sectional study

Background

Breast cancer is the most common female malignancy. Although chemotherapy is the primary treatment for breast cancer, it frequently has several detrimental side effects. Patients with breast cancer require self-compassion to regulate their emotions in order to cope with their suffering. Factors affecting self-compassion have mostly been investigated in the context of chronic diseases in general, not specifically in relation to patients receiving chemotherapy for breast cancer.

Objective

This cross-sectional study sought to describe the self-compassion level and to examine the predictive ability of self-critical judgment, body image, stress, attachment style, social support, hope, and self-reassuring on self-compassion among patients with breast cancer undergoing chemotherapy.

Methods

The participants were 210 Thai women with breast cancer who received chemotherapy in northern Thailand and were selected using proportionate random sampling. Data were collected from December 2021 to January 2023 using validated instruments. Data were analyzed using descriptive statistics and hierarchical regression analysis.

Results

Self-compassion was moderate (Mean = 2.91, SD = 0.91). Self-critical judgment (β = 0.487, p <0.001) and hope (β =0.128, p = 0.032) could predict self-compassion in patients with breast cancer undergoing chemotherapy and explained 40.1% of the variance.

Conclusion

The study's findings highlight the importance of addressing self-critical judgment and fostering hope in patients with breast cancer undergoing chemotherapy to enhance their self-compassion. Nurses and other healthcare providers can use the findings to provide interventions to promote self-compassion.

The Need to Look at Transgender and Gender Diverse People's Health: A Preliminary Descriptive Report on Pain, Sexual Distress, and Health Profile of Five Transmasculine People and One Non-Binary Person with Endometriosis

The sexual health of transgender and gender diverse (TGD) people with endometriosis has been overlooked, and important emotional experiences, such as sexual distress and its correlates, have been ignored. This has prevented a more comprehensive look at the health experiences of TGD individuals. This descriptive online survey study preliminarily explored the experiences of pain symptoms, sexual distress, and mental health of N = 6 TGD individuals diagnosed with endometriosis. Descriptive results showed a mean delay of 10 years from the onset of symptoms to the diagnosis. Endometriosis-related pain was a common symptom, although with low to moderate intensity. Results also showed higher mean levels of pain impact, powerlessness and lack of control, somatization, depression, anxiety, and sexual distress, and lower mean levels of emotional well-being, social support, and worse self-image compared to reports on cisgender women with endometriosis in the literature. These results suggested that sexual and mental health in the context of TGD people with endometriosis has specificities and may be associated with factors that need to be accounted for to provide comprehensive and socially just healthcare, such as the recognition of the impact of endometriosis treatment on symptoms of gender dysphoria. To achieve sexual health equity for TGD people, continuous and updated professional training and inclusive research with multiple informants are necessary.

Endometriosis, Pain, and Related Psychological Disorders: Unveiling the Interplay among the Microbiome, Inflammation, and Oxidative Stress as a Common Thread

Endometriosis (EM), a chronic condition in endometrial tissue outside the uterus, affects around 10% of reproductive-age women, significantly affecting fertility. Its prevalence remains elusive due to the surgical confirmation needed for diagnosis. Manifesting with a range of symptoms, including dysmenorrhea, dyschezia, dysuria, dyspareunia, fatigue, and gastrointestinal discomfort, EM significantly impairs quality of life due to severe chronic pelvic pain (CPP). Psychological manifestations, notably depression and anxiety, frequently accompany the physical symptoms, with CPP serving as a key mediator. Pain stems from endometrial lesions, involving oxidative stress, neuroinflammation, angiogenesis, and sensitization processes. Microbial dysbiosis appears to be crucial in the inflammatory mechanisms underlying EM and associated CPP, as well as psychological symptoms. In this scenario, dietary interventions and nutritional supplements could help manage EM symptoms by targeting inflammation, oxidative stress, and the microbiome. Our manuscript starts by delving into the complex relationship between EM pain and psychological comorbidities. It subsequently addresses the emerging roles of the microbiome, inflammation, and oxidative stress as common links among these abovementioned conditions. Furthermore, the review explores how dietary and nutritional interventions may influence the composition and function of the microbiome, reduce inflammation and oxidative stress, alleviate pain, and potentially affect EM-associated psychological disorders.

A Psychological Point of View on Endometriosis and Quality of Life: A Narrative Review

Endometriosis is a chronic gynecological disorder with a multifactorial etiology that has not yet been fully elucidated. What is known, however, are the pathological tissue dynamics that lead to the complex symptoms that women suffer from. The known symptoms are mainly fertility problems and pain. Both dimensions have an impact that varies from case to case, but that is certainly decisive concerning a woman's health, specifically by affecting the overall quality of life (QoL). In this publication, we will deal with the descriptive aspects of endometriosis's pathology and then present a review of the aspects impacting QoL and their psycho-social consequences. Finally, the experience of pain in the context of the mind-brain-body relationship will be discussed, describing the complexity of this dimension and emphasizing the importance of a multi-professional approach that considers the relevance of the contribution that a psychotherapy intervention based on up-to-date neurobiological models can make for women with endometriosis. A review of the literature and current knowledge on the neural and psychological aspects of pain lead to the conclusion that it is of the utmost importance to provide informed psychological support, alongside medical treatments and sexual counseling, to patients with endometriosis.

Self-compassion and health-related quality of life in individuals with endometriosis

OBJECTIVE

International research highlights the detrimental impact of endometriosis on health-related quality of life (HRQoL), yet few studies have examined positive resources such as self-compassion and resilience as correlates. This cross-sectional study aimed to examine the relationship between self-compassion and HRQoL in individuals with endometriosis in Aotearoa New Zealand. Resilience and perceived symptom severity were examined as potential mediators.

METHODS AND MEASURES

Six hundred and three individuals with endometriosis completed an online questionnaire measuring demographic and endometriosis-related information, endometriosis symptoms (number and severity), HRQoL, self-compassion and resilience.

RESULTS

In line with international research, the current sample reported significant impairment in all aspects of HRQoL. As expected, those with higher levels of self-compassion reported less impairment in HRQoL, and this relationship was partially mediated by perceived symptom severity (all aspects of HRQoL). Resilience mediated the relationship between self-compassion and two aspects of HRQoL (emotional wellbeing and control/powerlessness).

CONCLUSION

These findings confirm that HRQoL is significantly impaired in individuals with endometriosis in Aotearoa New Zealand and point to the potential role of self-compassion and resilience as protective factors in encouraging positive coping styles to manage symptoms and maintain high HRQoL. Interventions targeting self-compassion may be a promising tool to improve wellbeing in individuals with endometriosis.

Endometriosis and mental health disorders: identification and treatment as part of a multimodal approach

Endometriosis is a disease marked by more than just pain and infertility, as it transcends the well-characterized physical symptoms to be frequently associated with mental health issues. This review focuses on the associations between endometriosis and anxiety, depression, sexual dysfunction, and eating disorders, all of which show a higher prevalence in women with the disease. Studies show that pain, especially the chronic pelvic pain of endometriosis, likely serves as a mediating factor. Recent studies evaluating genetic predispositions for endometriosis and mental health disorders suggest a shared genetic predisposition. Healthcare providers who treat women with endometriosis should be aware of these associations to best treat their patients. A holistic approach to care by gynecologists as well as mental health professionals should emphasize prompt diagnosis, targeted medical interventions, and psychological support, while also recognizing the role of supportive relationships in improving the patient's quality of life.

Physical and psychosocial factors are crucial for maintaining physical and mental health in endometriosis: a longitudinal analysis

OBJECTIVE

To test the associations of physical and psychosocial factors with physical and mental health in individuals living with endometriosis (EM) by means of cross-sectional and longitudinal analyses.

METHODS AND MEASURES

Data were gathered via an online survey between February and August 2021. At survey date t1, sociodemographic, EM-related and psychosocial factors as well as physical and mental health of people with EM were assessed. At survey date t2 three months later, physical and mental health was reassessed. The sample consisted of n_t1 = 723 (30.60 ± 6.31 years) and n_t2 = 216 (30.56 ± 6.47 years) cis women with EM. Statistical analyses included bivariate and partial correlation analyses and hierarchical regression analyses.

RESULTS

The participants' physical health was within the average range and their mental health was below-average at t1 and t2. Cross-sectional analyses revealed that worse health was associated with longer diagnostic delay, more surgeries, greater pelvic pain and lower sense of coherence, self-efficacy, sexual satisfaction and satisfaction with the gynecological treatment. In longitudinal analyses, pelvic pain and participants' satisfaction with the gynecological treatment remained significantly associated with health.

CONCLUSION

Treatment should address both pelvic pain and psychosocial factors to improve long-term physical and mental health in EM.

The Perception of the Quality of Professional Healthcare Assistance for the Management of Endometriosis: Findings from a National Survey in Italy

(1) Background: endometriosis is included in the list of chronic and disabling pathologies. This study aimed to examine patients' points of view about the quality of care for endometriosis during the COVID-19 pandemic; (2) Methods: we conducted a survey on knowledge about endometriosis, management of endometriosis, perceived mental and physical well-being, and perceived changes in the quality of care during the pandemic; (3) Results: out of 1065 participants, 875 were included in the analysis, with an average age of 34. Overall, patients had positive perceptions of care accessibility and cleanliness (95%), but less satisfaction with visit hours (86%). Those with better physical and psychological health were more satisfied with service hours, while those treated at specialised centres were more content with cleanliness. Satisfaction with clarity was linked to specialist treatment, and perceived availability to listen correlated with age, complications, and overall health status; (4) Conclusions: patients' perspectives are crucial for patient education and advocate for specialised interdisciplinary networks to support endometriosis management and patients' well-being. These findings highlight the importance of considering patient viewpoints, particularly in the context of the COVID-19 pandemic's impact on healthcare systems and suggest a need for further research from the patient's perspective.

The impact of endometriosis on depressive and anxiety symptoms and quality of life: a systematic review

Introduction

Endometriosis is a common gynecological disorder affecting approximately 10-15% of women of reproductive age. The main complaints of patients with endometriosis are pain and fertility problems. Symptoms of endometriosis can impact the psychological functioning of the patients and significantly compromise their mental health.

Methods

The aim of this review was to assess the prevalence of depressive and anxiety symptoms and quality of life in endometriosis patients. For this systematic review, we searched the PubMed, MEDLINE, ProQuest, EMBASE, Cochrane, CINAHL, Google Scholar, Scopus, and ScienceDirect electronic databases up to March 2023 to identify potentially relevant studies. The systematic review in the present paper is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance.

Results

Of four records identified, 18 were eligible to be reviewed on the association between endometriosis and symptoms of depression and anxiety. Of 8,901 records identified, 28 were reviewed on the association between endometriosis and quality of life. The reviewed articles showed a prevalence ranging from 9.8 to 98.5% for depressive symptoms and 11.5 to 87.5% for anxiety. The quality of life in patients with endometriosis was significantly impaired, regardless of the tool used for evaluation.

Discussion

This systematic review shows that endometriosis is associated with depressive and anxiety symptoms and impaired HRQoL. Broad correlating factors modulate mental health outcomes, indicating the complex relationship between the disease and the psychological health of the patients.

Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective

Endometriosis is currently the second most common gynecological disease and is associated with severe pain, vegetative impairment, and infertility. In association, there are considerable psychological symptoms that limit the quality of life of those affected. In this narrative review, the Research Domain Criteria (RDoC) framework was utilized to display the different transdiagnostic processes involved in disease progression and maintenance in regard to psychosocial functioning. Using the RDoC framework, it becomes clear that immune/endocrinological dysregulation is interlocked with (pelvic) pain chronification processes and psychological symptoms such as depressive mood, loss of control, higher vigilance toward the onset or worsening of symptoms, social isolation, and catastrophizing. This paper will discuss and identify promising treatment approaches, in addition to medical care, as well as further research implications. Endometriosis can come with substantial psychosomatic and social burden, requiring more research to understand the interdependence of different factors involved in its chronic development pathway. However, it is already clear that standard care should be extended with multifaceted treatments addressing pain, as well as the psychological and social burden, in order to halt the cycle of aggravation of symptoms and to improve quality of life for patients.