Social Media, Endometriosis, and Evidence-Based Information: An Analysis of Instagram Content

Can the CANKADO online application improve quality of life monitoring via the endometriosis health profile-30 in endometriosis patients: A randomized cohort study on acceptance, usability, and correlations with demographics and media usage

BACKGROUND

The global increase in interest in endometriosis highlights the importance of further investigations concerning this so-called benign gynecological disease. Owing to their severe presentation of symptoms, patients suffer from an enormous impact on their health-related quality of life (HRQoL). While the paper-based assessment of quality of life via, e.g., the "Endometriosis Health Profile-30 questionnaire (EHP-30)" seems to be largely accepted and implemented, the electronic measurement of this patient-reported outcome (ePRO) is still rarely applied. This study aimed to analyze the acceptance and usability of electronic assessments of HRQoL in endometriosis patients via the online platform CANKADO.

METHODS

The study was conducted at the Department of Gynecology and Obstetrics of LMU Munich between January 2022 and February 2023. Sixty conservatively treated patients with endometriosis were recruited for the randomized cohort study, followed by randomization due to their planned interrogation modality (n paper-based = 23, n online-based = 17). Afterwards, a HRQoL assessment via the EHP-30 questionnaire was performed. An evaluation of the interrogation modalities was performed at 0, 6 and 12 months. The metric or categorical variables were compared via Fisher's exact test or the Mann‒Whitney U test. Correlation analysis was performed by calculating the Kendall Tau coefficient or Eta coefficient.

RESULTS

Forty patients completed evaluation forms at T0 (0 months), with n = 23 evaluating the paper-based interrogation modality and n = 17 evaluating the online version. At all the time of assessment, more than 80% of the patients showed a positive response to routinely performed ePRO measurements in the clinical context, expecting simplified communication, faster diagnosis, and therapeutic improvement. The online modality was rated more suitably (T0: 72.7% vs. 76.5%; T3: 60.0% vs. 90.0%), less complex (T0: 59.1% vs. 76.5%; T3: 80.0% vs. 70.0%), and less laborious (T0: 72.7% vs. 70.6%; T3: 80% each). Completion time over ten minutes was significantly correlated with low coping ability (r = 0.530; p = 0.029), lower clarity (r = 0.530; p = 0.029) and greater effort (r = 0.593; p = 0.012).

CONCLUSIONS

The findings indicate high acceptance and usability of regularly performed ePRO assessments in patients with endometriosis via the online tool CANKADO.

Endometriosis in Adolescence: A Narrative Review of the Psychological and Clinical Implications

Endometriosis is a chronic, inflammatory condition where endometrial-like tissue grows outside the uterus, affecting around 10% of women of reproductive age. This condition is associated with debilitating symptoms, including dysmenorrhea, dyspareunia, chronic pelvic pain, fatigue, and infertility. Adolescents with endometriosis face unique challenges, as the disease is often misdiagnosed or undiagnosed for an average of 7-10 years due to its complex and multifactorial nature. Consequently, patients frequently suffer from worsening symptoms and significant psychological distress, including anxiety, depression, and social withdrawal. While there is no definitive cure for endometriosis, treatment approaches typically involve hormonal therapies, lifestyle adjustments (such as diet and exercise), and psychological support. Recent studies emphasize the profound impact of endometriosis on the mental health of adolescents, highlighting the need for a more holistic treatment approach that integrates both medical and psychological care. This narrative review explores the psychological and psychosocial effects of endometriosis in adolescents, examining the biological and psychological mechanisms linking the disease to mental health outcomes. It also discusses current therapeutic strategies, such as cognitive behavioral therapy, mindfulness, and peer support, and underscores the importance of early diagnosis and multidisciplinary care to mitigate both the physical and emotional burdens of the condition. This integrated approach is critical in improving the overall well-being and quality of life for adolescents living with endometriosis.

Informational support for women with endometriosis: a scoping review

BACKGROUND

Ten per cent of women of reproductive age suffer from endometriosis, a painful and incurable disease that leaves women with severe implications for their health and overall well-being. Due to the absence of a cure and the limited effectiveness of available treatments, acquiring accurate information is paramount for women to successfully navigate both their daily lives and the complexities of the healthcare system. This scoping review aimed to map the current literature on women with endometriosis information needs, their information seeking behaviour, and the format and scope of current information resources available.

METHODS

The scoping review was conducted using the JBI methodology for scoping reviews and reported according to the PRISMA-ScR statement. The final search was conducted in August 2024, through the databases Medline, Cinahl, Embase, Scopus, and WebofScience. Studies on information resources on endometriosis and information seeking behaviour as well as information needs of women with endometriosis were eligible for inclusion.

RESULTS

The majority of the 25 included studies focused on information resources, specifically webpages and social media sites. While few studies analysed information seeking behaviour and information needs, the evidence shows women's high interest in a broad spectrum of information topics. Across all studies, the internet was the most important access point for information.

CONCLUSION

Addressing the absence of systematic analyses on the information seeking behaviour and needs of women with endometriosis is crucial for future research. This step is essential for the development of customised information resources that cater specifically to the diverse needs of women affected by endometriosis.

Menstrual Health Symptoms and Literacy among Young Women in Aotearoa New Zealand: A Nationwide Cross-Sectional Survey

STUDY OBJECTIVE

To explore menstrual cycle symptoms, information sources, and menstrual health literacy in young women (age 13-25) and those who menstruate in Aotearoa New Zealand DESIGN AND SETTING: A cross-sectional online survey in Aotearoa New Zealand was used.

PARTICIPANTS

The participants were 1334 respondents (age 13-25 years, mean age 19.8) who had had at least 3 periods and were currently living in New Zealand.

INTERVENTIONS

An online survey was hosted by Qualtrics between October 2021 and January 2022.

MAIN OUTCOME MEASURES

Information was obtained on menstrual cycle characteristics and symptoms and menstrual health literacy.

RESULTS AND CONCLUSIONS

Respondents reported high rates of regular dysmenorrhea (89%), fatigue/tiredness (78.1%), and mood changes (72.5%) associated with menstruation. A higher proportion of rangatahi (younger generation) Māori reported irregular cycles (53.5%) compared with non-Māori respondents (41.7%). Normalization of symptoms, especially pain (80.2%), was high. Most respondents recognized the need to see a doctor for period pain that impacted their daily lives (84.7%). However, noncyclical pelvic pain (45.7%), heavy bleeding (39%), and intermenstrual bleeding (29%) were less likely to be recognized as symptoms that require a doctor's visit. The main sources of menstrual health knowledge before menarche were a family member (74.2%) and health and physical education classes at school (63.7%). Many young people reported receiving little or no information about periods before menarche (37.9%), with very few respondents receiving information on how to manage menstrual symptoms (15.1%). Menstrual symptoms are common, and the provision of culturally safe information and opportunities to learn is important for young people, whānau, schools, and health care practitioners.

Social media activism and women's health: Endometriosis awareness and support

Objective

While endometriosis is estimated to affect 1 in 10 women globally, awareness of the disease as well as research and funding to fight the disease remains lacking as compared with other chronic diseases. This study examines how social media users utilized Instagram to raise awareness of and mobilize activism around endometriosis by analyzing prominent topics, word associations, and feminism themes in endometriosis-tagged posts on Instagram.

Methods

We used a mixed-method approach of combining computational analyses (topic modeling and word association) and human coding (qualitative thematic analysis) of Instagram posts on endometriosis.

Results

Our results show that while Instagram users discussed a variety of issues related to the disease on the social media platform, these issues tend to focus on four topic areas: (i) living with endometriosis, (ii) pregnancy and endometriosis, (iii) awareness and empowerment, and (iv) women's health and wellbeing. In addition, social media users widely incorporated three feminism themes: (i) bringing attention to invisible disability, (ii) solidarity and support among women, and (iii) advocacy and activism around women's health.

Conclusion

People with endometriosis use Instagram to create an online public sphere for raising awareness of the disease, offering networking and support to other endometriosis patients, and creating a movement for enhancing women's health and wellness. In doing so, they are also addressing sexism and misconceptions about endometriosis that have traditionally contributed to normalizing women's experience of pain associated with endometriosis and consequently delaying endometriosis diagnoses.

Low Diet Quality and Nutritional Knowledge in Women with Endometriosis: A Pilot Study

Endometriosis is a chronic gynecological disease characterized by ectopic endometrial tissue outside the uterus that can cause chronic pain, dysmenorrhea, fatigue, and infertility. The aim of this study was to assess diet quality and nutritional knowledge of women with endometriosis. A questionnaire was used to collect data on lifestyle, dietary habits and nutritional knowledge from 90 women. More than 80% of women with endometriosis (82.2%) confirmed that diet and lifestyle are related to the progression of endometriosis. After being diagnosed with endometriosis, 77.3% of respondents reported a change in their dietary habits and made various changes to their diet by increasing or eliminating the consumption of certain foods. The majority declared reducing pro-inflammatory products, increasing anti-inflammatory foods, including the consumption of vegetables and fruits, avoiding white/or red/or processed meat, and avoiding sweets. Nevertheless, diet quality as assessed by the pro-healthy diet index (pHDI-10) and the Mediterranean Diet Score (MDS) showed a low intensity of consumption of pro-healthy food (average pHDI-10 value 31.4%; MDS 7.55/14 points, p = 0.0001). Women with endometriosis reported lower than recommended consumption of fruits, vegetables, dairy products and whole grains. A higher percentage of healthy controls had a "good" level of nutritional knowledge than women with endometriosis. The results of our study highlight the need to improve diet quality and nutritional knowledge among women with endometriosis as well as developing targeted dietary recommendations to help improve well-being and reduce the pain symptoms of endometriosis.