Effects of the SARS-CoV-2 pandemic on women affected by endometriosis: a large cross-sectional online survey

Figures & data

Figure 1. Percentage distribution of Impact of Event Scale (IES-R) total score among the study participants (n = 468).

Notes: IES-R cut-offs to define normal (0–8), mild (9–25), moderate (26–43) and severe (44–88) post-traumatic stress symptoms are marked as dashed vertical lines.

Table 1. Characteristics of the study patients (n = 468). Values are counts (percentages) or mean ± standard deviation [interquartile range].

Patient characteristic
Age, y	38.8 ± 7.7 [33–45]
Age group, y
≤20	3 (0.6)
21–29	49 (10.5)
30–39	190 (40.6)
40–49	192 (41.0)
≥50	34 (7.3)
Living alone	66 (14.1)
Being a parent	151 (32.3)
Educational attainment
Lower secondary	36 (7.7)
Upper secondary	196 (41.9)
Tertiary	176 (37.6)
Other	60 (12.8)
Work during lockdown
Unemployed	70 (15.0)
Stopped working	87 (18.6)
Worked from home	177 (37.8)
Went to work	134 (28.6)
Previous surgery for endometriosis	300 (64.1)
Waitlisted for surgery	26 (5.6)
Seeking pregnancy before lockdown
No	386 (82.5)
Yes, not postponed	54 (11.5)
Yes, postponed	28 (6.0)
Waitlisted for fertility testing
No	429 (91.7)
Yes, postponed by the hospital	26 (5.6)
Yes, postponed by me	13 (2.8)
Hormonal treatment during lockdown
No	159 (34.0)
Yes, easy to access	241 (51.5)
Yes, a little difficult to access	26 (5.6)
Yes, quite difficult to access	24 (5.1)
Yes, very difficult to access	11 (2.4)
Yes, virtually impossible to access	7 (1.5)
Concerned about not having access to specialist care
No	58 (12.4)
A little	89 (19.0)
Quite	153 (32.7)
Very	91 (19.4)
Extremely	77 (16.5)
Worried for her health
No	99 (21.2)
A little	72 (15.4)
Quite	160 (34.2)
Very	101 (21.6)
Extremely	36 (7.7)
Dysmenorrhoea, NRS	2.5 ± 3.2 [0–5]
Presence of dysmenorrhoea (NRS > 0)	233 (49.8)
Chronic pelvic pain, NRS	2.8 ± 3.0 [0–5]
Presence of chronic pelvic pain (NRS > 0)	282 (60.3)
Dyspareunia, NRS	2.4 ± 3.2 [0–4]
Presence of dyspareunia (NRS > 0)	227 (48.5)
Dyschezia, NRS	2.1 ± 2.8 [0–4]
Presence of dyschezia (NRS > 0)	239 (51.1)
Dysuria, NRS	1.1 ± 2.2 [0–1]
Presence of dysuria (NRS > 0)	129 (27.6)
Worsening of symptoms during lockdown	61 (13.0)
Sexual intercourses during lockdown	274 (58.5)
EHP-5 scoring	25.4 ± 20.2 [11.4–36.4]
GAD-7 scoring	7.9 ± 4.8 [4–11]
STAI-Y6 scoring	48.4 ± 13.2 [36.7–60.0]

NRS: numeric rating scale; EHP-5: Short Form Endometriosis Health Profile; GAD-7: Generalized Anxiety Disorder 7-item; STAI-Y6: Spielberg State Trait Anxiety Inventory 6-item.

Table 2. Results of simple (bivariate) linear regression analysis for subjective distress caused by SARS-COV-2 pandemic, as measured by the Impact of Event Scale (IES-R) total score.

Patient characteristic	Regression coefficient	p-value	95% confidence interval
			Lower bound	Upper bound
Age, y	0.16	.080	–0.02	0.35
Living alone
No	Ref.
Yes	3.05	.149	–1.10	7.20
Being a parent
No	Ref.
Yes	–1.16	.442	–4.14	1.81
Educational attainment
Lower secondary	Ref.
Upper secondary	1.77	.517	–3.60	7.15
Tertiary	0.73	.788	–4.57	6.02
Other	1.31	.680	–4.91	7.53
Work during lockdown
Unemployed	Ref.
Stopped working	–3.63	.127	–8.30	1.04
Worked from home	–3.82	.094	–8.30	0.66
Went to work	–7.94	.001*	–12.41	–3.46
Previous surgery for endometriosis
No	Ref.
Yes	0.40	.779	–2.42	3.23
Waitlisted for surgery
No	Ref.
Yes	1.51	.583	–3.90	6.92
Seeking pregnancy before lockdown
No	Ref.
Yes, not postponed	–2.85	.155	–6.78	1.08
Yes, postponed	–2.08	.496	–8.09	3.92
Waitlisted for fertility testing
No	Ref.
Yes, postponed by the hospital	–0.17	.947	–5.20	4.86
Yes, postponed by me	–4.67	.189	–11.65	2.31
Hormonal treatment during lockdown
No	Ref.
Yes, easy to access	–0.19	.902	–3.14	2.77
Yes, a little difficult to access	0.09	.979	–6.56	6.74
Yes, quite difficult to access	3.08	.305	–2.82	8.99
Yes, very difficult/virtually impossible to access	11.35	.007*	3.13	19.57
Concerned about not having access to specialist care
No	Ref.
A little	1.02	.650	–3.39	5.42
Quite	5.09	.014*	1.04	9.14
Very	3.84	.084	–0.51	8.18
Extremely	12.46	<.001*	7.67	17.24
Worried for her health
No	Ref.
A little	4.04	.066	–0.27	8.35
Quite	5.71	.001*	2.36	9.06
Very	11.42	<.001*	7.25	15.59
Extremely	14.14	<.001*	7.23	21.04
Dysmenorrhoea, NRS	0.83	<.001*	0.38	1.27
Chronic pelvic pain, NRS	1.24	<.001*	0.78	1.69
Dyspareunia, NRS	1.05	<.001*	0.62	1.48
Dyschezia, NRS	1.32	<.001*	0.83	1.81
Dysuria, NRS	1.16	<.001*	0.56	1.76
Worsening of symptoms during lockdown
No	Ref.
Yes	6.13	.005*	1.83	10.42
Sexual intercourses during lockdown
No	Ref.
Yes	–2.10	.138	–4.88	0.68
EHP-5 scoring	0.04	.276	–0.03	0.10
GAD-7 scoring	1.98	<.001*	1.74	2.21
STAI-Y6 scoring	0.54	<.001*	0.45	0.63

*Significant at the 5% level.

Table 3. Results of multivariable linear regression analysis for subjective distress caused by SARS-COV-2 pandemic, as measured by the Impact of Event Scale (IES-R) total score.

Patient characteristic	Regression coefficient	p-value	95% confidence interval
			Lower bound	Upper bound
Age, y	0.28	.001*	0.12	0.44
Living alone
No	Ref.
Yes	1.66	.371	–1.99	5.32
Being a parent
No	Ref.
Yes	0.41	.710	–1.77	2.60
Educational attainment
Lower secondary	Ref.
Upper secondary	1.62	.531	–3.46	6.70
Tertiary	2.62	.309	–2.43	7.66
Other	4.40	.126	–1.25	10.04
Work during lockdown
Unemployed	Ref.
Stopped working	–1.99	.329	–6.00	2.01
Worked from home	–3.31	.069	–6.88	0.26
Went to work	–4.79	.010*	–8.44	–1.15
Previous surgery for endometriosis
No	Ref.
Yes	0.28	.820	–2.13	2.69
Waitlisted for surgery
No	Ref.
Yes	–2.27	.362	–7.15	2.62
Seeking pregnancy before lockdown
No	Ref.
Yes, not postponed	1.11	.528	–2.34	4.56
Yes, postponed	0.58	.844	–5.23	6.39
Waitlisted for fertility testing
No	Ref.
Yes, postponed by the hospital	–0.42	.871	–5.55	4.71
Yes, postponed by me	–2.98	.295	–8.56	2.60
Hormonal treatment during lockdown
No	Ref.
Yes, easy to access	1.98	.127	–0.57	4.53
Yes, a little difficult to access	0.13	.954	–4.42	4.69
Yes, quite difficult to access	4.62	.071	–0.40	9.64
Yes, very difficult/virtually impossible to access	6.87	.020*	1.11	12.63
Concerned about not having access to specialist care
No	Ref.
A little	–1.03	.571	–4.58	2.53
Quite	1.46	.424	–2.13	5.05
Very	–0.62	.750	–4.42	3.19
Extremely	2.28	.303	–2.06	6.62
Worried for her health
No	Ref.
A little	3.15	.082	–0.40	6.70
Quite	3.64	.014*	0.74	6.55
Very	5.42	.003*	1.85	8.99
Extremely	5.48	.062	–0.27	11.23
Dysmenorrhoea, NRS	0.28	.224	–0.17	0.74
Chronic pelvic pain, NRS	0.10	.729	–0.49	0.70
Dyspareunia, NRS	0.39	.071	–0.03	0.81
Dyschezia, NRS	0.34	.191	–0.17	0.84
Dysuria, NRS	–0.55	.062	–1.13	0.03
Worsening of symptoms during lockdown
No	Ref.
Yes	0.32	.862	–3.26	3.90
Sexual intercourses during lockdown
No	Ref.
Yes	–0.02	.985	–2.30	2.26
EHP-5 scoring	–0.01	.748	–0.06	0.04
GAD-7 scoring	1.71	<.001*	1.38	2.05
STAI-Y6 scoring	0.01	.796	–0.10	0.13

The adjusted R² of the model is 0.432. * Significant at the 5% level.

Table 4. Relationship of specific signs of generalized anxiety disorder (GAD-7 items) with subjective distress caused by SARS-COV-2 pandemic, as measured by the Impact of Event Scale (IES-R) total score.

Items of the GAD-7 scale	Regression coefficient	p-value	95% confidence interval
			Lower bound	Upper bound
Feeling nervous, anxious, or on edge	1.22	.340	–1.29	3.73
Not being able to stop or control worrying	–0.27	.828	–2.72	2.18
Worrying too much about different things	3.32	.009*	0.82	5.82
Trouble relaxing	1.19	.265	–0.91	3.28
Being so restless that it is hard to sit still	2.11	.035*	0.15	4.07
Becoming easily annoyed or irritable	1.77	.044*	0.05	3.49
Feeling afraid as if something awful might happen	2.87	.002*	1.02	4.72

Regression coefficients are adjusted for the demographic and clinical characteristics listed in Tables 1 and 2. *Significant at the 5% level.

Data availability statement

Tha data analysed in this paper cannot be made open in compliance with the study protocol.