{"paper_id":"0159373e-c899-4320-b68f-0d747b180a4f","body_text":"REVIEW | OPEN ACCESS   \n \n \n \nMedical Science 28, e160ms3483 (2024)                                                                                                                                                                1 of 7 \n \nThe impact of endometriosis on \nwomen's mental health and \nquality of life – review \n \nPaweł Nowocin1*, Zuzanna Kudas1, Martyna Koszyk2, \nAleksandra Litwin1, Karolina Krzywicka3, Dawid Wiktor \nKulczyński1, Natalia Dąbrowska4, Paulina Kumięga1, \nNikola Perchel1, Piotr Wasiński5 \n \n \nABSTRACT \nEndometriosis is a chronic medical condition where tissue resembling the uterine \nlining grows outside the uterus, impacting pelvic organs. This ectopic tissue \ngrowth results in a variety of symptoms ranging from chronic pain to \ndysmenorrhea and dyspareunia, predicaments that have a profound impact on \ndaily life quality, leading to an important impairment of its quality (QoL). The \ncondition impacts women in their full -fertile years, occurring in 10% of the \npopulation and up to 50% of infertile women —highlighting it as a significant \nissue for reproductive health and mental well -being. In this review, we examine \nthe impact that endometriosis has on rates of depression, anxiety, and social \nwithdrawal and how emotional stress is further exacerbated by diagnostic delays. \nThis can also create relational distress as the condition often affects sexual health \nand interpersonal relationships. Good care does not just provide physical \nmanagement but also psychological and mental health support. Given this, social \nsupport and the adoption of adaptive coping strategies among women with \nendometriosis can help them cope effectively with their disease, increase their \nemotional resilience, and abandon the use of mental health services. As a result, \ncomprehensive care models that integrate physical health, mental health, and \nsocial support may be crucial to improving the QoL of endometriosis -affected \nwomen. \n \nKeywords: Endometriosis, Mental health, Quality of life, Depression, Anxiety. \n \n \n1. INTRODUCTION  \nEndometriosis is a chronic gynecological disorder characterized by the presence \nand growth of tissue —similar to the endometrial lining that grows within the \nuterus each cycle before shedding during menstruation —outside of the uterine \ncavity on pelvic organs such as ovaries, fallopian tubes, and peritoneum (Burney \nMedical Science \n \n \n \nTo Cite: \nNowocin P, Kudas Z, Koszyk M, Litwin A, Krzywicka K, Kulczyński \nDW, Dąbrowska N, Kumięga P, Perchel N, Wasiński P. The impact of \nendometriosis on women's mental health and quality of life – review. \nMedical Science 2024; 28: e160ms3483 \ndoi: https://doi.org/10.54905/disssi.v28i154.e160ms3483  \n \nAuthors’ Affiliation: \n1Medical University of Warsaw, Żwirki i Wigury 61, 02 -091 Warszawa, Poland  \n2Cardinal Stefan Wyszyński University in Warsaw, Dewajtis 5, 01 -815 Warsaw, Poland \n3SPKSO Ophthalmic University, Hospital in Warsaw, Józefa Sierakowskiego 13, 03 -709 Warszawa, Poland \n4Military Institute of Medicine –National Research Institute, ul. Szaserów 128, 04 -141 Warszawa, Poland \n5Provincial Hospital in Kielce, Grunwaldzka 45, 25 -736 Kielce, Poland \n  \n*Corresponding Author  \nMedical University of Warsaw, Żwirki i Wigury 61, 02 -091 Warszawa,  \nPoland \nEmail: p.nowocin@wp.pl  \n \nContact List \nPaweł Nowocin  p.nowocin@wp.pl \nZuzanna Kudas  md.zuzannakudas@gmail.com  \nMartyna Koszyk  martyna.koszyk@icloud.com  \nAleksandra Litwin  aleks.litwin123@gmail.com \nKarolina Krzywicka                   karolinakrzywicka08@gmail.com  \nDawid Wiktor Kulczyński  dawid.wiktor.kulczynski@gmail.com  \nNatalia Dąbrowska   nataldabrowska@gmail.com  \nPaulina Kumięga  paulina.kumiega@wum.edu.pl  \nNikola Perchel  nikolaperchel@interia.pl \nPiotr Wasiński  p_wasinski@interia.pl \n  \nORCID List \nPaweł Nowocin  0009-0007-2018-6139 \nZuzanna Kudas   0009-0009-6750-6886 \nMartyna Koszyk  0009-0000-9927-6020 \nAleksandra Litwin  0009-0004-3221-0085 \nKarolina Krzywicka  0009-0001-3248-4674 \nDawid Wiktor Kulczyński  0009-0003-3897-1507 \nNatalia Dąbrowska  0009-0009-7170-0614 \nPaulina Kumięga  0009-0005-1431-0231 \nNikola Perchel  0009-0005-6489-7480 \nPiotr Wasiński   0009-0009-3824-3618 \n \nPeer-Review History \nReceived: 20 September 2024 \nReviewed & Revised: 24/September/2024 to 24/December/2024 \nAccepted: 28 December 2024 \nPublished: 30 December 2024 \n \nPeer-review Method \nExternal peer-review was done through double-blind method. \n \nMedical Science \npISSN 2321–7359; eISSN 2321–7367 \n \n \n© The Author(s) 2024. Open Access. This article is licensed under a Creative \nCommons Attribution License 4.0 (CC BY 4.0)., which permits use, sharing, \nadaptation, distribution and reproduction in any medium or format, as long as \nyou give appropriate credit to the original author(s) and the source, provide a \nlink to the Creative Commons license, and indicate if changes were made. To \nview a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. \n \n \n \n \n \n \n \n \n \nDISCOVERY \nSCIENTIFIC SOCIETY \n \n\n \nREVIEW | OPEN ACCESS   \n \n \n \nMedical Science 28, e160ms3483 (2024)                                                                                                                                                                2 of 7 \nand Giudice, 2012; Koninckx et al., 2021). These ectopic endometrial implants respond to hormonal fluctuations, causing inflammation, \npain, and the production of scar tissue and adhesions, which can impair the capacity to carry out daily activities (Eskenazi and Warner, \n1997). It has been described by symptoms such as dysmenorrhea, chronic pelvic pain, and dyspareunia, which significantly affe ct QoL \nin affected women (Rahmioglu et al., 2023).  \nEndometriosis is a common gynecological condition with incriminating clinical implications that potentially afflicts around 1 0% of \nwomen of reproductive age globally (Burney and Giudice, 2012; Bulun et al., 2019). In fact, among women facing infertility problems, \nup to 25% to 50% may be affected by endometriosis, illustrating a graded relationship between endometriosis and reproductive health \ncomplications (Buck-Louis et al., 2011). Symptoms typically begin in adolescence but are most often diagnosed in women aged 25 –35 \nyears old (Bulun et al., 2019). The length of time it takes for a diagnosis is one of the most challenging things about endom etriosis. With \nsymptoms being nonspecific and some of the expected pain during menstruation, many women, on average, wait 7 to 11 years befo re \nreceiving a proper diagnosis (Koninckx et al., 2021).  \nThis diagnostic timeline is also prolonged by the surgical diagnosis requirement (laparoscopy as an invasive procedure) (Eske nazi \nand Warner, 1997). Even though endometriosis etiology is not completely clear, several hypotheses indicate a complex multifactorial \nmodel in which genetic, immunological, hormonal, and environmental components play a key role (Eskenazi and Warner, 1997; \nRahmioglu et al., 2023). A well -known hypothesis is retrograde menstruation, in which menstrual blood flows backward through the \nfallopian tubes into the pelvic cavity; however, it has not been able to explain why only some women develop the disease, so there are \nother possible biological factors implicated (Burney and Giudice, 2012).  \nThe diversity of symptoms and the often-unpredictable course of the disease contribute significantly to impairing the quality of life \nin women living with endometriosis. Endometriosis is associated with chronic pain and dysmenorrhea, which lead to high emotio nal \ndistress in many patients, such as depression, infertility, anxiety, and social isolation (Bulun et al., 2019). A complete un derstanding of \nthe multifaceted nature of endometriosis and its effects on health in general, mental well -being, and overall quality of life is necessary \nto ensure that therapeutic approaches are broad enough not only to tackle the physical symptoms but also to meet the psycholo gical \nand social needs relating to women with this chronic condition. \n \n2. MATERIALS AND METHODS \nA thorough literature review was carried out to collect detailed information on how endometriosis affects women's mental heal th and \nquality of life. The search utilized databases that included PubMed and PubMed Central. Search terms were strategically selec ted to \ncapture relevant studies and included “endometriosis”, “mental health”, “quality of life”, “depression”, “anxiety”. \n \n3. RESULTS AND DISCUSSION \nSymptoms and Health-related Quality of Life \nEndometriosis-associated physical symptoms impair QoL in women since this disease is associated with multiple systemic conditions. \nIts clinical presentation invariably includes the most common and classical symptom of severe cyclical chronic pelvic pain, w hich may \nlead to significant impairment. The widespread chronic pain changes various aspects, including physical mobility and the desi re to \nparticipate in social life —gathering with friends and doing loads of activities at work —all culminating in a vastly lower rate of life \nsatisfaction (Matasariu et al., 2017).  \nDysmenorrhea (painful menstruation) is another common symptom that disturbs daily performance, decreases productivity, and \ndeteriorates the quality of life because experiencing pain for a long time can lead to reduced mental health in women due to the distress \nof continuous uneasiness (Adoamnei et al., 2021). Additional physical symptoms, such as dyspareunia and fatigue, only add to the \nburden faced by women with endometriosis. Dyspareunia can be stressful to an intimate relationship, and undisclosed, it may, in some \ncases, result in emotional injury and psychological pain. Fatigue, in turn, makes the physical problem worse by restricting e nergy \nMuharam et al., (2022) and impairing women to balance personal activities with professional jobs.  \nMoreover, gastrointestinal and urinary symptoms are key to understanding that many women with endometriosis may face the \noverall complexity burden, which challenges daily life management and affects emotional resilience and social engagement \n(Pontoppidan et al., 2023). Chronic and multi -component symptoms lead to reduced QoL, as shown in life's physical, emotional, and \nsocial aspects. These symptoms are unpredictable and upsetting, with research indicating that due to their extreme nature, th ere is \n\n \nREVIEW | OPEN ACCESS   \n \n \n \nMedical Science 28, e160ms3483 (2024)                                                                                                                                                                3 of 7 \nevidence that significant social isolation is experienced as a result of symptom severity, leading to women withdrawing from social \ncontact with others for reasons of distress or embarrassment (Mikocka-Walus et al., 2021).  \nMoreover, work productivity and career promotion are also interfered with by the restrictions physically imposed by poor heal th \ndue to frequent absenteeism and loss of functional capacities at work (Bień et al., 2020). Together with chronic pain, fatigu e, and issues \naround reproduction, endometriosis weaves an endless web of suffering, both physically and mentally. It reflects a broad rang e of \nimpacts on multiple life domains. It underlines the importance of treatment that encompasses physical as well as psychologica l and \nsocial aspects of living with endometriosis. \n \nDepression, Anxiety and Endometriosis \nMany women with it suffer from impaired mental health, including depression and anxiety. One of the leading causes cited for these \nmental health conditions is chronic pain and reproductive challenges associated with endometriosis. This condition often caus es severe \ndysmenorrhea, chronic pelvic pain, and dyspareunia, contributing to additional emotional distress in these women, who are als o at a \ngreater risk of developing depressive symptoms compared to non -endometriotic patients with similar levels of body mass index. \nDepression in women affected by endometriosis is significantly common, according to the literature.  \nPerpetuity of pain and the imposed constraints on daily functioning, social (isolation), professional (career consequences), as well as \ninteractionally are factors that may result in feelings of hopelessness, loss of self -esteem, and loss of life satisfaction (Gambadauro et al., \n2019; Waller and Shaw, 1995). Long -term and cyclic pain, furthermore, can make life feel unpredictable to daily reality and create \npossibly more significant stress alongside emotional exhaustion (Sims et al., 2021). Anxiety is a mental health issue that af fects many \nwomen with endometriosis. This results in increased anxiety because symptoms will go up and down, and unfortunately, many \nwomen experience long delays before getting a diagnosis. Especially the uncertainty of pain and anxiety about fertility probl ems \nincreases the sense of worry and concern (Walker et al., 1989; Kessler and Bromet, 2013).  \nSpecific to infertility, research highlights how pervasive the anxieties that accompany reproductive difficulties can be give n the \nadditional psychological burdens infused by social and relational strains triggered increasingly in a world where we live —and \nreproduce—longer lives (Cavaggioni et al., 2014; Hansen et al., 2023). Continual experiences of depression and anxiety over time, \ncoupled with physiological changes the body undergoes when they take place simultaneously, can contribute to a sort of feedba ck loop \nthat exacerbates physical strain associated with endometriosis and transmutes into increased pain sensitivity accompanied by a \nrecurrence in psychological suffering. Findings suggest the potential co -morbidities between physical and mental health and, hence, \nmay inform integrated healthcare approaches for women with endometriosis.  \nInterventions focused on pain, psychological support, and stress reduction may help relieve both physical and mental symptoms , \nleading to better QoL (DiVasta et al., 2018; Estes et al., 2021). Complementary treatment approaches that include mental heal th \ninterventions, like cognitive -behavioral therapy and mindfulness -based interventions, have demonstrated efficacy in decreasing \ndepression and anxiety in women with endometriosis. To enhance the psychological support and quality of life in women with \nendometriosis, it is necessary to address these modifiable personal resources for them to feel more competent in coping with the \nmultifaceted aspects of their illness (Moreira et al., 2022; Sims et al., 2021). \n \nInfluence on Sex and Relationships in Women with Endometriosis \nOne of those ways is in the effect that endometriosis takes on women and intimate romantic relationships as well as social co nnections. \nThe data indicate that dyspareunia, pain during or after intercourse, is common among women with endometriosis and can be a \nsignificant barrier to having a satisfying sex life (Wahl et al., 2020). Ongoing discomfort and concern about pain in sex oft en lead to \ninhibited sexual desire and avoidance behaviors, leading to stress and frustration within a relationship (Young et al., 2018) . When \ncompared to those without endometriosis, women with the disease experience sexual dysfunction and have lower levels of sexual  \nsatisfaction and frequency (Del -Forno et al., 2023). It is in part because the impacts of endometriosis are not just restricted to physical \npain, but they have an impact on relationships, both emotional and intimate.  \nMen who have partners with endometriosis often describe emotions of sadness, guilt, and fear, reporting that they feel helple ss, \nfrustrated, and worried about their partner, which can lead to relational strain and diminished emotional closeness (Young et  al., 2016). \nIndeed, the psychological toll of coping with pain and sexual dysfunction may result in partners feeling emotionally disconne cted from \none another as both have to deal with it without proper help or communication tools with these issues ( De-Ziegler et al., 2010). This \n\n \nREVIEW | OPEN ACCESS   \n \n \n \nMedical Science 28, e160ms3483 (2024)                                                                                                                                                                4 of 7 \nstigma, combined with societal misunderstandings about the condition, only serves to compound endometriosis' effects on sexua l \nhealth and relationships.  \nWomen living with the condition frequently express feelings of isolation because family members and friends cannot always \nappreciate how much they struggle, which serves only to reinforce both their sense of alienation and limits reassuring social  support \n(Caruso et al., 2019). Having a network and reducing isolation is important, as research has suggested that social support on its own is \nassociated with fewer physical and emotional symptoms for women living with endometriosis (Shum et al., 2018). Considering th e \nmulti-dimensional impact of endometriosis on sexual life and relationships, healthcare providers should be informed to address thes e \naspects as a part of comprehensive care.  \nTherapeutic interventions with a component of counseling, couple therapy, or support groups can be helpful for women and thei r \npartners regarding specific relationship problems secondary to endometriosis (Practice Committee of the American Society for \nReproductive Medicine, 2006). Further, women with endometriosis require a holistic approach that addresses physical and \npsychological support to improve quality of life and relationship satisfaction (Barnhart et al., 2022; Prescott et al., 2016). \n \nSocial support and coping strategies \nWith several studies highlighting the significance of social support in improving mental health and quality of life Denny, (2004), it is \nclear that women with endometriosis rely heavily on others to deal with the physical and emotional strains associated with th e \ncondition. In other words, women with endometriosis who have supportive family members, as well as understanding and empathet ic \nfriends or healthcare providers, tend to report familiar (or lower) levels of psychological distress compared to those withou t vital \nsupport systems (Carey et al., 2014). The tangible and intangible aspects of social support not only insulate women from feel ings of \nisolation but also work to cultivate resilience in their journey with the chronic, unpredictable nature of endometriosis (Hun tington and \nGilmour, 2005). \nParticipation in peer support groups is a common coping strategy used by women with endometriosis, who attend these groups to  \nengage in experiential sharing, gain information, and receive social validation from other women experiencing similar challen ges \n(Bylinka and Oniszczenko, 2016). Research indicates that peer support groups offer a distinct space where women can recognize they \nare not isolated in their experiences and challenges (Markovic et al., 2008). These groups might have the potential to be ver y helpful for \npromoting adaptive coping as they provide emotional support, practical advice, and a sense of community that is often lacking  in their \nimmediate social environments (Andysz and Merecz-Kot, 2020). \nThe mental health consequences of endometriosis may also take their toll as chronic pain and restrictions can contribute to a  sense \nof helplessness and frustration Denny, (2004), making effective coping strategies that much more vital. For instance, women with \nendometriosis have been found to reframe their illness experience and find meaning through adaptive coping strategies such as  \nproblem-focused coping and cognitive restructuring (Carey et al., 2014). Conversely, avoidant coping mechanisms like suppression and \nemotional disengagement or withdrawal are less effective for good mental health and are associated with higher levels of anxi ety and \ndepression (Markovic et al., 2008).  \nSupportive psychoeducation can be an integral component of comprehensive care for women with endometriosis (Andysz  and \nMerecz-Kot, 2020). (p.3) Combining social support with coping strategies can prove a powerful weapon to alleviate the mental health \nstatus and quality of life for those women living with endometriosis. Due to the positive emotional effects associated with b elonging to \na support network and receiving coping skills training, healthcare providers might also consider planning for such facets in \ncomprehensive treatment (Huntington and Gilmour, 2005). \n \nCurrent Research Limitations \nAlthough there are rich insights in the reviewed studies, limitations remain. Most studies are cross -sectional, which may not establish \ncausality between endometriosis and mental health outcomes (Dowding et al., 2024; Kessler  and Bromet, 2013). Small sample sizes and \nheterogeneity in study designs make it challenging to generalize findings (Walker et al., 1989; Hansen et al., 2023). Longitu dinal \nresearch is also required to learn about the long -term psychological outcomes of FD and intervention effectiveness over time (Waller  \nand Shaw, 1995; Prescott et al., 2016).  A gap in the literature appears concerning cultural factors that affect the presentation and course \nof endometriosis, which may limit our ability to capture all aspects contributing to the global burden of this disease (Bulun  et al., 2019; \nPrescott et al., 2016). \n\n \nREVIEW | OPEN ACCESS   \n \n \n \nMedical Science 28, e160ms3483 (2024)                                                                                                                                                                5 of 7 \nClinical Practice and Future Research Implications \nThe results emphasize the importance of taking a broad view and a 'whole person' approach to managing treatments for endometr iosis \nby healthcare professionals. Early diagnosis and treatment are very important for reducing the physical and mental stresses a ssociated \nwith the disease (Koninckx et al., 2021; Eskenazi and Warner, 1997). Mental health assessment should be included as part of routine \ncare, and referrals to mental health services should be made as indicated in women with endometriosis (Sims et al., 2021; Den ny, 2004). \nThe development of standardized screening tools for psychological distress in this population might be helpful in improving a nd \nenabling earlier identification and treatment (Cavaggioni et al., 2014; Carey et al., 2014). \nConsequently, the generalization of findings would also improve in subsequent longitudinal and larger -scale research with more \ndiversity in their populations (Walker et al., 1989; Andysz  and Merecz-Kot, 2020). Further investigation into adjunctive national \ndemedicalized, psychological, or social treatment models that may be able to offer nuanced differences in clinical efficacy would help to \ninform patient and community -centered care at the most efficacious level (Moreira et al., 2022; Practice Committee of the American \nSociety for Reproductive Medicine, 2006). Meanwhile, investigating the cultural, socio -economic, and individual aspects of coping and \nresilience can provide necessary data for tailoring preventive strategies accordingly (Estes et al., 2021; Huntington and Gilmour, 2005). \n \n4. CONCLUSION \nAddressing the broader impact of endometriosis requires an integrated and holistic approach that combines physical symptom \nmanagement with psychological and social support. Effective treatment strategies should include mental health support, such a s \ncounseling and cognitive-behavioral therapy, to alleviate depression and anxiety. Additionally, incorporating social support networks, \npeer groups, and adaptive coping strategies can enhance resilience and help women better navigate the challenges of endometri osis. In \nsum, comprehensive care models that address endometriosis's physical and psychosocial dimensions are crucial for improving th e \noverall quality of life for women affected by this complex condition. \n \nAuthor’s Contributions \nConceptualization: Paweł Nowocin, Nikola Perchel, Zuzanna Kudas \nFormal Analysis Investigation: Martyna Koszyk, Aleksandra Litwin, Karolina Krzywicka \nResources: Piotr Wasiński, Paweł Nowocin, Dawid Wiktor Kulczyński \nWriting – Rough Preparation: Natalia Dąbrowska, Paweł Nowocin, Nikola Perchel, Zuzanna Kudas, Martyna Koszyk, Aleksandra \nLitwin, Karolina Krzywicka, Piotr Wasiński, Dawid Wiktor Kulczyński, Paulina Kumięga \nVisualization: Paweł Nowocin, Dawid Wiktor Kulczyński, Zuzanna Kudas \nProject Administrator: Paweł Nowocin \n \nInformed Consent  \nNot Applicable \n \nEthical approval \nNot applicable \n \nFunding  \nThis study has not received any external funding. \n \nConflict of interest  \nThe authors declare that there is no conflict of interests. \n \nData and materials availability \nAll data sets collected during this study are available upon reasonable request from the corresponding author. \n \n\n \nREVIEW | OPEN ACCESS   \n \n \n \nMedical Science 28, e160ms3483 (2024)                                                                                                                                                                6 of 7 \nREFERENCES \n1. Adoamnei E, Morán-Sánchez I, Sánchez -Ferrer ML, Mendiola \nJ, Prieto -Sánchez MT, Moñino -García M, Palomar -Rodríguez \nJA, Torres -Cantero AM. Health -Related Quality of Life in \nAdult Spanish Women with Endometriomas or Deep \nInfiltrating Endometriosis: A Case -Control Study. Int J \nEnviron Res Public Health 2021; 18(11):5586. doi: 10.3390/ijerp  \nh18115586 \n2. Andysz A, Merecz -Kot D. Predictors of illness acceptance in \nwomen with endometriosis. Health Psychol Rep 2020; 9(3):24  \n0-251. doi: 10.5114/hpr.2020.97914 \n3. Barnhart K, Dunsmoor -Su R, Coutifaris C. Effect of \nendometriosis on in vitro fertilization. Fertil Steril 2002; 77(6):  \n1148-1155. doi: 10.1016/s0015-0282(02)03112-6 \n4. Bień A, Rzońca E, Zarajczyk M, Wilkosz K, Wdowiak A, \nIwanowicz-Palus G. Quality of life in women with \nendometriosis: a cross-sectional survey. Qual Life Res 2020; 29  \n(10):2669-2677. doi: 10.1007/s11136-020-02515-4 \n5. Buck-Louis GM, Hediger ML, Peterson CM, Croughan M, \nSundaram R, Stanford J, Chen Z, Fujimoto VY, Varner MW, \nTrumble A, Giudice LC; ENDO Study Working Group. \nIncidence of endometriosis by study population and \ndiagnostic method: the ENDO study. Fertil Steril 2011; 96(2):3  \n60-5. doi: 10.1016/j.fertnstert.2011.05.087 \n6. Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, \nKohlmeier A, Yin P, Milad M, Wei J. Endometriosis. Endocr \nRev 2019; 40(4):1048-1079. doi: 10.1210/er.2018-00242 \n7. Burney RO, Giudice LC. Pathogenesis and pathophysiology of \nendometriosis. Fertil Steril 2012;  98(3):511–519. doi: 10.1016/j.f \nertnstert.2012.06.029    \n8. Bylinka J, Oniszczenko W. Temperament, Beliefs About Pain \nControl, and Pain Intensity in Endometriosis Patients. J Clin \nPsychol Med Settings 2016; 23(4):410 -419. doi: 10.1007/s10880 -\n016-9473-8 \n9. Carey ET, Martin CE, Siedhoff MT, Bair ED, As -Sanie S. \nBiopsychosocial correlates of persistent postsurgical pain in \nwomen with endometriosis. Int J Gynaecol Obstet 2014; 124  \n(2):169-73. doi: 10.1016/j.ijgo.2013.07.033 \n10. Caruso S, Iraci M, Cianci S, Vitale SG, Fava V, Cianci A. \nEffects of long -term treatment with Dienogest on the quality \nof life and sexual function of women affected by \nendometriosis-associated pelvic pain. J Pain Res 2019; 12:2371 -\n2378. doi: 10.2147/JPR.S207599 \n11. Cavaggioni G, Lia C, Resta S, Antonielli T, Benedetti -Panici P, \nMegiorni F, Porpora MG. Are mood and anxiety disorders \nand alexithymia associated with endometriosis? A \npreliminary study. Biomed Res Int 2014; 2014:786830. doi: 10.  \n1155/2014/786830 \n12. Del-Forno S, Cocchi L, Arena A, Pellizzone V, Lenzi J, Raffone \nA, Borghese G, Paradisi R, Youssef A, Casadio P, Raimondo \nD, Seracchioli R. Effects of Pelvic Floor Muscle Physiotherapy \non Urinary, Bowel, and Sexual Functions in Women with \nDeep Infiltrating Endometriosis: A Randomized Controlled \nTrial. Medicina (Kaunas) 2023; 60(1):67. doi: 10.3390/medicina  \n60010067 \n13. Denny E. Women's experience of endometriosis. J Adv Nurs \n2004; 46(6):641-8. doi: 10.1111/j.1365-2648.2004.03055.x \n14. De-Ziegler D, Borghese B, Chapron C. Endometriosis and \ninfertility: pathophysiology and management. Lancet 2010; 37  \n6(9742):730-8. doi: 10.1016/S0140-6736(10)60490-4 \n15. DiVasta AD, Vitonis AF, Laufer MR, Missmer SA. Spectrum \nof symptoms in women diagnosed with endometriosis during \nadolescence vs adulthood. Am J Obstet Gynecol 2018; 218(3):3  \n24.e1-324.e11. doi: 10.1016/j.ajog.2017.12.007 \n16. Dowding C, Mikocka -Walus A, Skvarc D, O'Shea M, Olive L, \nEvans S. Learning to cope with the reality of endometriosis: A \nmixed-methods analysis of psychological therapy in women \nwith endometriosis. Br J Health Psychol 2024; 29(3):644 -661. \ndoi: 10.1111/bjhp.12718 \n17. Eskenazi B, Warner ML. Epidemiology of endometriosis. \nObstet Gynecol Clin North Am 1997; 24(2):235 -58. doi: 10.101  \n6/s0889-8545(05)70302-8 \n18. Estes SJ, Huisingh CE, Chiuve SE, Petruski -Ivleva N, Missmer \nSA. Depression, Anxiety, and Self -Directed Violence in \nWomen with Endometriosis: A Retrospective Matched-Cohort \nStudy. Am J Epidemiol 2021; 190(5):843 -852. doi: 10.1093/aje/k \nwaa249 \n19. Gambadauro P, Carli V, Hadlaczky G. Depressive symptoms \namong women with endometriosis: a systematic review and \nmeta-analysis. Am J Obstet Gynecol 2019; 220(3):230 -241. doi: \n10.1016/j.ajog.2018.11.123 \n20. Hansen KE, Brandsborg B, Kesmodel US, Forman A, Kold M, \nPristed R, Donchulyesko O, Hartwell D, Vase L. Psychological \ninterventions improve quality of life despite persistent pain in \nendometriosis: results of a 3 -armed randomized controlled \ntrial. Qual Life Res 2023; 32(6):1727-1744. doi: 10.1007/s11136-0 \n23-03346-9 \n21. Huntington A, Gilmour JA. A life shaped by pain: women and \nendometriosis. J Clin Nurs 2005; 14(9):1124 -32. doi: 10.1111/j.1 \n365-2702.2005.01231.x \n\n \nREVIEW | OPEN ACCESS   \n \n \n \nMedical Science 28, e160ms3483 (2024)                                                                                                                                                                7 of 7 \n22. Kessler RC, Bromet EJ. The epidemiology of depression across \ncultures. Annu Rev Public Health 2013; 34:119 -38. doi: 10.114  \n6/annurev-publhealth-031912-114409 \n23. Koninckx PR, Fernandes R, Ussia A, Schindler L, Wattiez A, \nAl-Suwaidi S, Amro B, Al -Maamari B, Hakim Z, Tahlak M. \nPathogenesis Based Diagnosis and Treatment of \nEndometriosis. Front Endocrinol (Lausanne) 2021; 12:745548. \ndoi: 10.3389/fendo.2021.745548 \n24. Markovic M, Manderson L, Warren N. Endurance and \ncontest: women's narratives of endometriosis. Health \n(London) 2008; 12(3):349-67. doi: 10.1177/1363459308090053  \n25. Matasariu RD, Mihaila A, Iacob M, Dumitrascu I, Onofriescu \nM, Crumpei -Tanasa I, Vulpoi C. Psycho -social aspects of \nquality of life in women with endometriosis. Acta Endocrinol \n(Buchar) 2017; 13(3):334-339. doi: 10.4183/aeb.2017.334 \n26. Mikocka-Walus A, Druitt M, O'Shea M, Skvarc D, Watts JJ, \nEsterman A, Tsaltas J, Knowles S, Harris J, Dowding C, Parigi \nE, Evans S. Yoga, cognitive -behavioural therapy versus \neducation to improve quality of life and reduce healthcare \ncosts in people with endometriosis: a randomised controlled \ntrial. BMJ Open 2021;  11(8):e046603. doi: 10.1136/bmjopen -202 \n0-046603 \n27. Moreira MF, Gamboa OL, Pinho Oliveira MA. A single -blind, \nrandomized, pilot study of a brief mindfulness -based \nintervention for the endometriosis -related pain management. \nEur J Pain 2022; 26(5):1147-1162. doi: 10.1002/ejp.1939 \n28. Muharam R, Amalia T, Pratama G, Harzif AK, Agiananda F, \nMaidarti M, Azyati M, Sumapraja K, Winarto H, Wiweko B, \nHestiantoro A, Suarthana E, Tulandi T. Chronic Pelvic Pain in \nWomen with Endometriosis is Associated with Psychiatric \nDisorder and Quality of Life Deterioration. Int J Womens \nHealth 2022; 14:131-138. doi: 10.2147/IJWH.S345186 \n29. Pontoppidan K, Olovsson M, Grundström H. Clinical factors \nassociated with quality of life among women with \nendometriosis: a cross -sectional study. BMC Womens Health \n2023; 23(1):551. doi: 10.1186/s12905-023-02694-5 \n30. Practice Committee of the American Society for Reproductive \nMedicine. Endometriosis and infertility. Fertil Steril 2006; 86(5 \nSuppl 1):S156-60. doi: 10.1016/j.fertnstert.2006.08.014 \n31. Prescott J, Farland LV, Tobias DK, Gaskins AJ, Spiegelman D, \nChavarro JE, Rich -Edwards JW, Barbieri RL, Missmer SA. A \nprospective cohort study of endometriosis and subsequent \nrisk of infertility. Hum Reprod 2016; 31(7):1475 -82. doi: 10.109 \n3/humrep/dew085 \n32. Rahmioglu N, Mortlock S, Ghiasi M, Møller PL, Stefansdottir \nL, Galarneau G, Turman C, Danning R, Law MH, Sapkota Y, \nChristofidou P, Skarp S, Giri A, Banasik K, Krassowski M, \nLepamets M, Marciniak B, Nõukas M, Perro D, Sliz E, … \nZondervan KT. The genetic basis of endometriosis and \ncomorbidity with other pain and inflammatory \nconditions. Nat Genet 2023; 55(3):423–436. doi: 10.1038/s41588-\n023-01323-z \n33. Shum LK, Bedaiwy MA, Allaire C, Williams C, Noga H, \nAlbert A, Lisonkova S, Yong PJ. Deep Dyspareunia and \nSexual Quality of Life in Women with Endometriosis. Sex \nMed 2018; 6(3):224-233. doi: 10.1016/j.esxm.2018.04.006 \n34. Sims OT, Gupta J, Missmer SA, Aninye  IO. Stigma and \nEndometriosis: A Brief Overview and Recommendations to \nImprove Psychosocial Well -Being and Diagnostic Delay. Int J \nEnviron Res Public Health 2021; 18(15):8210. doi: 10.3390/ijerp  \nh18158210 \n35. Wahl KJ, Orr NL, Lisonek M, Noga H, Bedaiwy MA, Williams \nC, Allaire C, Albert AY, Smith KB, Cox S, Yong PJ. Deep \nDyspareunia, Superficial Dyspareunia, and Infertility \nConcerns Among Women with Endometriosis: A Cross -\nSectional Study. Sex Med 2020; 8(2):274 -281. doi: 10.1016/j.esx  \nm.2020.01.002 \n36. Walker E, Katon W, Jones LM, Russo J. Relationship between \nendometriosis and affective disorder. Am J Psychiatry 1989; 1  \n46(3):380-1. doi: 10.1176/ajp.146.3.380 \n37. Waller KG, Shaw RW. Endometriosis, pelvic pain, and \npsychological functioning. Fertil Steril 1995; 63(4):796-800. doi: \n10.1016/s0015-0282(16)57484-6 \n38. Young K, Fisher J, Kirkman M. Endometriosis and fertility: \nwomen's accounts of healthcare. Hum Reprod 2016; 31(3):554 -\n62. doi: 10.1093/humrep/dev337 \n39. Young K, Kirkman M, Holton S, Rowe H, Fisher J. Fertility \nexperiences in women reporting endometriosis: findings from \nthe Understanding Fertility Management in Contemporary \nAustralia survey. Eur J Contracept Reprod Health Care 2018; \n23(6):434-440. doi: 10.1080/13625187.2018.1539163","source_license":"CC0","license_restricted":false}