Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference

Abstract

Introduction: No prior study of endometriosis has investigated the psychological impact of having asymptomatic endometriosis versus endometriosis with pelvic pain in a systematic way. This study aimed at examining the impact of endometriosis on quality of life, anxiety and depression by comparing asymptomatic endometriosis, endometriosis with pelvic pain, and healthy, pain-free controls. The psychological impact of different types of endometriosis pain was also tested.

Methods: One hundred and ten patients with surgically diagnosed endometriosis (78 with pelvic pain and 32 without pain symptoms) and 61 healthy controls completed two psychometric tests assessing quality of life, anxiety and depression. Endometriosis participants indicated on a numerical rating scale the intensity of four types of pain (dysmenorrhea, dyspareunia, non-menstrual pelvic pain and dyschezia).

Results: Endometriosis patients with pelvic pain had poorer quality of life and mental health as compared with those with asymptomatic endometriosis and the healthy controls. No significant differences were found between asymptomatic endometriosis and the control group. Dysmenorrhea had significant effects only on physical quality of life; non-menstrual pelvic pain affected all the variables; no significant effects were found for dyspareunia and dyschezia.

Conclusions: Pain significantly affects women’s experience of endometriosis. The medical treatment of endometriosis with pain may not be sufficient and psychological intervention is recommended.

• Anxiety
• depression
• endometriosis
• pelvic pain
• quality of life

Acknowledgements

We thank Dr Andrea Bonanomi for help with statistical analyses. We also thank the Reviewers for their commendable job and the precious suggestions provided.

Declaration of interest

The authors report no conflicts of interest.

Current knowledge on the subject

• Several studies have demonstrated that endometriosis impairs women’s quality of life and mental health.

• Some of these studies have investigated the impact of endometriosis as a chronic inflammatory gynecological disease and some others have specifically focused on the effects of pelvic pain as the most common endometriosis symptom.

What this study adds

• We investigate whether the quality of life and mental health of women with endometriosis are negatively affected by the fact of having a chronic inflammatory disease such as endometriosis, although asymptomatic, or only by the presence of pelvic pain associated with endometriosis.

• We demonstrate that the mere fact of having endometriosis (when asymptomatic) may not necessarily affect women's quality of life and mental health (i.e. anxiety and depression).

• We highlight that having pelvic pain leads to poorer quality of life and mental health.

• We show that four different types of endometriosis pain (i.e. dysmenorrhea, dyspareunia, non-menstrual pelvic pain and dyschezia) have different effects on women’s quality of life and mental health and we address new ideas for future research and clinical intervention with endometriosis patients.