Physical therapy and psychological intervention normalize cortisol levels and improve vitality in women with endometriosis

Abstract

There is as yet no effective treatment for endometriosis. The objective of this study was to evaluate the effectiveness of submitting women with endometriosis and chronic pelvic pain to a therapeutic protocol involving physical and psychological therapy. Twenty-six female volunteers were submitted to a treatment protocol consisting of 2.5-h sessions, once a week for 10 weeks. We applied a Visual Analogue Scale, the Perceived Stress Questionnaire (PSQ), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Morning, afternoon, and evening levels of cortisol were determined in saliva samples. The PSQ scores were significantly lower after treatment, whereas the scores for the SF-36 vitality and physical functioning domains were significantly higher. Salivary cortisol levels were higher after treatment in the samples collected in the morning, but not in those collected in the afternoon or evening. The post-treatment cortisol levels were similar to those reported for healthy women. There were positive correlations between vitality, role emotional, social functioning, and mental health, and negative correlations to perceived stress. In conclusion, the physical and psychological intervention protocol applied in this study to women suffering of endometriosis was effective in reducing perceived stress, normalizing cortisol levels, increasing vitality and improving physical functioning.

Keywords::

• Awakening cortisol response
• chronic pelvic pain
• endometriosis
• hypocortisolism
• perceived stress levels
• SF-36
• therapeutic intervention

Declaration of Interest: This study was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, São Paulo Research Foundation; Grant no. 03/09173-3) and the Coordenadoria de Aperfeiçoamento de Pessoal de Ensino Superior (CAPES, Office for the Advancement of Higher Education).

Current knowledge on this subject

• There is as yet no effective treatment for endometriosis. To date, neither classical therapies, such as surgery and pharmacological therapy, nor alternative therapies have proven effective in treating endometriosis. In addition, despite the high health care costs and morbidity associated with the disease, its incidence, prevalence, and risk factors, as well as factors influencing the effectiveness of therapy, remain uncertain.

What this study adds

• Current data indicate that women with endometriosis and pelvic pain of moderate intensity suffer from high levels of perceived stress, poor health-related quality of life, and hypocortisolism. The proposed treatment reduced perceived stress, increased vitality, improved physical functioning, and normalized salivary cortisol levels.