Impact of endometriosis on women's health-related quality of life: A national prospective cohort study

Pelvic peritoneal endometriosis is linked to the endometrial inflammatory profile: a prospective cohort study

BACKGROUND

Pelvic endometriosis is an estrogen-driven inflammatory syndrome of unknown origin that alters the peritoneal microenvironment and likely impairs endometrial receptivity, adversely affecting fertility. Chronic endometritis (CE) may be a potential contributing factor to reduced endometrial receptivity in endometriosis. The aim of the study was to analyze the correlation between pelvic endometriosis and CE.

METHODS

The study included women undergoing laparoscopy for suspected pelvic endometriosis, and each underwent endometrial aspiration biopsy for CE. The stage of endometriosis was assessed intraoperatively, and CE activity was evaluated histopathologically and immunohistochemically. The associations between selected clinical characteristics of the disease and the density of endometrial plasma cells, immunohistochemical status, and histopathological profile of the endometrium were analyzed.

RESULTS

Stage III endometriosis reduced the risk of the inflammatory immunohistochemical profile by 80% (OR = 0.18, p = 0.037) when compared to Stage I. Peritoneal endometriosis was associated with a 3.429-fold increase in the risk of the immunohistochemical endometrial inflammatory profile (OR = 3.429, p = 0.038). No significant associations were found between the clinical features of the disease and plasma cell density or the histopathological profile of the endometrium (all p values > 0.05). No significant differences were observed in IVF use (p = 0.67), pregnancy rates (p = 1), or live birth rates (p = 0.41) between infertile women with and without CE.

CONCLUSIONS

Should peritoneal endometriosis be diagnosed during a laparoscopy conducted for the treatment of infertility, it is advisable to obtain an endometrial biopsy for CE evaluation, as this may enhance the efficacy of the therapeutic approach. The hypothetical link between pelvic endometriosis-related inflammation, its clinical manifestations, and CE requires further investigation. The lack of a noninvasive marker for endometriosis and its grade limits the study results due to reliance on surgical cases, highlighting the need for advanced research in the field of noninvasive diagnostic tools.

TRIAL REGISTRATION

NCT05824507 (registered April 20, 2023).

Psychological Distress and Quality of Life in Women With Endometriosis: A Narrative Review of Therapeutic Approaches and Challenges

The chronic gynecological disorder endometriosis is a debilitating condition for women's physical and psychological health. Endometriosis is a disease that causes endometrial-like tissue to grow outside the uterus and causes debilitating symptoms, including chronic pain, fatigue, and infertility. Women with endometriosis often suffer from psychological distress, especially anxiety, depression, and social isolation, which aggravates the whole burden. The purpose of this review was to review the psychological impact of endometriosis and its influence on quality of life (QoL) and examine the relationship between physical symptomatology and mental health. It also discusses current therapeutic approaches: medical treatment, psychological interventions, and complementary therapies, and problems of delayed diagnosis, poor multidisciplinary care, and stigma. An integrated care model combining physical and psychological support is required as concluded from the review. Recommendations for future research are made, specifically in the areas of personalized care strategies and improving healthcare access to improve outcomes for women with endometriosis.

Nutrition Interventions in the Treatment of Endometriosis: A Scoping Review

BACKGROUND

Pain, poor quality of life (QOL) and gastrointestinal (GI) symptoms are commonly experienced by individuals with endometriosis. Although diet and nutrition supplements are frequently used to manage endometriosis-related symptoms, there is limited understanding of the breadth and quality of research in this field. Our aim was to undertake a scoping review of diet and nutrition supplement intervention studies in people with endometriosis, diagnosed by ultrasound or surgery.

METHODS

MEDLINE Complete, Embase, CINAHL and PsycINFO databases were searched for articles published in English from database inception to November 2024. Quality was assessed by two reviewers independently using the Joanna Briggs Institute appraisal tools. In total, 5130 publications were screened and 13 were included.

RESULTS

Among these, five evaluated the effect of diet intervention, one evaluated the effect of a combined diet-supplement intervention and seven evaluated the effect of a nutrition supplement in endometriosis. Overall, there were seven randomised controlled trials (RCTs) (n = 1 diet intervention, n = 6 nutrition supplement), two nonrandomised controlled studies (n = 1 diet intervention, n = 1 combined diet-supplement) and four uncontrolled studies (n = 3 diet intervention, n = 1 nutrition supplement). On the basis of evidence from the RCTs, the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet improved QOL and GI symptoms, whereas garlic supplements and combination trace element supplements may be beneficial for improving reduced pain symptoms related to endometriosis. The quality of most included studies was poor. Adherence to the interventions was only measured in five studies and only one diet study measured baseline diet.

CONCLUSIONS

High-quality RCTs of diet and nutrition supplement interventions are needed to progress the understanding of whether they should be integrated into the clinical management of endometriosis.

Hospitalisations and length of stays in women with endometriosis: a data linkage prospective cohort study

Background

Women with endometriosis have more hospitalisations compared to those without the condition. However, no longitudinal study has examined hospital admission rates and lengths of stay before and after diagnosis. We examined all-cause hospital admissions and lengths of stay among women with, versus without, endometriosis, and before, versus after, diagnosis.

Methods

This study included 13,501 women of reproductive age, born in 1973-78. The Australian Longitudinal Study on Women's Health survey data linked to administrative health records was used to identify women with endometriosis. Hospital admission rates and length of stays were examined using hospital records of patients admitted up to 2022. Analysis was conducted using mixed-effects zero-inflated negative binomial models.

Findings

Women with endometriosis were more likely to be admitted to hospitals compared to those without the condition, with an adjusted incidence rate ratio (IRR) of 2.11 (95% CI: 1.83-2.43) for admissions per year. However, they had shorter hospital stays (IRR: 0.90; 0.81-0.99) for days per year and were more often discharged on the same day (odds ratio: 1.27; 1.20-1.33). Post-diagnosis, women experienced more hospitalisations and more days in hospital compared to their pre-diagnosis (IRR: 1.52; 1.22-1.88) and (IRR: 1.81; 1.53-2.14), respectively. Consistent findings were found for women with surgically confirmed or clinically suspected endometriosis.

Interpretation

The higher number of hospitalisations among women with endometriosis, compared to those without, highlights the substantial burden of the condition on healthcare utilisation. The persistent frequent hospitalisations and longer stays post-diagnosis indicate recurrent endometriosis, posing significant management challenges.

Funding

The Australian Longitudinal Study on Women's Health is funded by the Australian Government Department of Health and Aged Care. GDM and GWM are Australian National Health and Medical Research Council Leadership Fellows (GNT2009577 and GNT1177194).

Quality of life identification by unsupervised cluster analysis: A new approach to modelling the burden of endometriosis

BACKGROUND

Symptoms frequently associated with endometriosis affect quality of life (QoL). Our aim investigated the hypothesis that cluster analysis can be used to identify homogeneous phenotyping subgroups of women according to the burden of the endometriosis for their QoL, and then to investigate the phenotype differences observed between these subgroups.

METHODS

We developed an anonymous online survey, which received responses from 1,586 French women with endometriosis. K-means, a major clustering algorithm, was performed to show structure in data and divide women into groups based on the burden of endometriosis. This was defined using 9 dimensions. Multivariable logistic regression was performed to highlight the association between QoL and several factors. Covariables were age, BMI, smoking, education, children, marital status and surgery.

RESULTS

K-means clustering was implemented with 8 clusters (optimal CCC value of 17.2162). In one cluster, women presented a high level of QoL and represented 234 women for 60% of women with a high level of QoL, and another with 410 women for 34% of women with worse QoL. Independent factors determining high QoL were age (over 45 years compared to below 25 years, OR = 0.17 [0.07-0.46], p<0.001), BMI (high vs low, OR = 0.47 [0.28-0.80], p = 0.005), having children (OR = 0.30 [0.18-0.48], p<0.001), having surgery for endometriosis (OR = 0.55 [0.32-0.94], p = 0.029), and education (high vs low, OR = 2.75 [1.75-4.31], p<0.001).

CONCLUSION

Cluster analysis identifies homogeneous women phenotypes for QoL with endometriosis. Implementing new methodological approaches improves QoL of endometriosis women and allows appropriate preventive strategies.

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.

Loneliness and Perceived Social Support in Endometriosis: The Roles of Body Image Disturbance and Anticipated Stigma

BACKGROUND

Research has identified that living with the chronic inflammatory disease endometriosis adversely impacts social functioning and interpersonal relationships, specifically, feelings of loneliness and a lack of perceived social support. Commonly experienced body image disturbance (BID), combined with the anticipation of endometriosis-related stigma from others, may result in further social withdrawal. This study aimed to quantitatively investigate the association between BID and social functioning (loneliness and diminished perceived social support), and the potential moderating effect of anticipated stigma on these associations.

METHOD

Participants (N = 212) with a self-reported endometriosis diagnosis completed an online questionnaire measuring social and emotional loneliness, perceived social support, BID, anticipated stigma and demographic and medical characteristics.

RESULTS

Mean scores indicated high levels of BID, emotional loneliness and diminished perceived social support. Bootstrapped multivariable regression analyses indicated that BID was significantly associated with greater emotional loneliness and lower perceived social support. BID was also associated bivariately with greater social loneliness. Anticipated stigma from healthcare workers moderated the association of BID with perceived social support, such that poorer perceived support was reported when anticipated stigma was high, despite the presence of minimal BID.

CONCLUSION

These findings highlight the psychological challenges of living with endometriosis in terms of highly prevalent BID, in the context of feeling lonely and poorly supported. The further negative impact of anticipated stigma suggests that psychosocial interventions may benefit from additionally targeting these perceptions of stigma.

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.

Quality of life and symptoms of pain in patients with endometriomas compared to those with other endometriosis lesions: a cross-sectional study

BACKGROUND

Endometriomas are genetically distinct from other endometriosis lesions and could be associated with a predisposition to excessive inflammation. However, differences in clinical presentation between types of endometriosis lesions have not been fully elucidated. This study aimed to investigate the quality of life and pain scores of patients with endometriomas compared to those with other types of endometriosis lesions.

METHODS

A cross-sectional observational study was conducted between January 2020 and August 2023. Patients diagnosed with endometriosis completed the Endometriosis Health Profile 30 pain subscale questionnaire for their quality of life score and rated their endometriosis-associated pain symptoms using an 11-point numerical rating scale. The data were analyzed for comparison through multivariate linear regression models.

RESULTS

A total of 248 patients were included and divided into endometrioma (81, 33%) and nonendometrioma (167, 67%) groups. The mean age of the patients was 37.1 ± 7.5 years. Most participants were Canadian or North American (84%). One-third of the patients reported experiencing up to four concurrent pain symptoms. The most reported pain included deep dyspareunia (90%), chronic pelvic pain (84%) and lower back pain (81%). The mean quality of life score was 45.9 ± 25.9. We observed no difference in quality of life scores between patients with and without endometriomas. Patients with endometriomas had lower mean scores for deep dyspareunia (0.8; 95% CI [0 to 1.5]; p = 0.049) and higher mean scores for superficial dyspareunia (1.4; 95% CI [0.2 to 2.6]; p = 0.028). Comorbid infertility (p = 0.049) was a factor that modified superficial dyspareunia intensity in patients with endometriomas.

CONCLUSION

In patients with endometriosis, evidence was insufficient to conclude that the presence of endometriomas was not associated with a greater or lesser quality of life, but differences in specific symptoms of dyspareunia were identified.