Mental health, menstrual and other pain symptoms are more common in women with endometriosis, according to a recent study published in the American Journal of Obstetrics and Gynecology.1
Endometriosis, characterized by endometrial-like tissue outside the uterus, is reported in 11.4% of Australian women aged 44. Endometriosis increases the risk of hospitalization and decreases work productivity and quality of life.
The average time from symptom onset to diagnosis is 7 to 11 years, leading to increased symptoms, hospitalizations, and healthcare resource use. Data also indicated that women with endometriosis are at increased risk of chronic pelvic pain, heavy menstrual bleeding, dyspareunia, dyschezia, dysmenorrhea, and fatigue.
Most data on endometriosis and common symptoms come from cross-sectional or descriptive studies. Investigators assessed the association between endometriosis and common symptoms using data from the Australian Longitudinal Study on Women’s Health (ALSWH), a large prospective population-based cohort study.
More than 40,000 women across three age cohorts were included in the ALSWH. Patients responded to 8 consecutive surveys via postal or online questionnaires. The surveys were carried out every 3 years between 1996 and 2018.
In the present analysis, patients born between 1973 and 1978 who completed symptom checklist surveys from 2009 to 2018 were included. Self-reported surveys and administrative health records were evaluated to determine the incidence of endometriosis.
Endometriosis was classified as clinically suspected or surgically confirmed, with a diagnosis of endometriosis recorded in the Medicare Benefits Schedule (MBS) or hospital data used to define surgically confirmed endometriosis. Endometriosis cases confirmed only by self-report or endometriosis medication prescriptions were defined as clinically suspected endometriosis.
Women’s symptoms were assessed using data from self-reported surveys from 2009, 2012, 2015 and 2018. Women were asked whether they had experienced symptoms in the previous 12 months. Response options included never, rarely, sometimes, and often.
Symptoms included allergies, headaches, severe fatigue, indigestion, difficulty breathing, joint stiffness, back pain, foot problems, skin problems, premenstrual tension, palpitations, pain severe menstrual bleeding, heavy menstrual bleeding, irregular periods, leaking urine, burning urine, vaginal irritation. , hemorrhoids, constipation and intestinal problems.
Covariates included women’s age, marital status, residence, income, education, alcohol consumption, smoking, physical activity, body mass index, contraceptive use and parity.
7,606 women were included in the final analysis, with 1,149 cases of endometriosis reported in this population, 565 surgically confirmed and 584 clinically suspected. Endometriosis was more common in women who were underweight, living in urban areas, and sedentary.
Overall, symptoms were more common in women with endometriosis. Symptoms seen more often in women with endometriosis include mental, menstrual, urinary, bowel, and other nonspecific symptoms. These associations were observed after adjusting for covariates, but endometriosis was not associated with skin problems, urine leakage, or difficulty breathing.
Endometriosis was significantly associated with menstrual symptoms, including heavy menstrual bleeding, severe menstrual pain, premenstrual tension, and irregular periods. Mental health symptoms, including depression, anxiety, and other menstrual problems, were also more common among women with endometriosis.
Somatic and allergic symptoms were reported more in women with endometriosis, as well as severe fatigue, back pain, allergies, headaches, joint stiffness and foot problems with odds ratios of 1.79, 1.76, 1.50, 1.62, 1.65 and 1.53 respectively. The risk of palpitations increased by 77% in women with endometriosis and difficulty sleeping by 56%.
In women with endometriosis, constipation, hemorrhoids or hemorrhoids, as well as indigestion or heartburn, the risks increased by 67%, 46% and 25% respectively. Urinary burning and vaginal irritation were also more common in women with endometriosis.
These associations were found in both surgically confirmed and clinically suspected endometriosis, indicating a wide range of symptoms associated with endometriosis. The investigators recommended further studies to evaluate potential biological pathways between endometriosis and associated symptoms.
This article was originally published in Contemporary OB/GYN.
