{"paper_id":"1cef905e-2a5a-44bb-b489-6fb4b3361417","body_text":"153 \nInternational Journal of Clinical Obstetrics and Gynaecology 2026; 10(4): 153-157 \n \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \nIndexing: Embase \nImpact Factor (RJIF): 6.71 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2026; 10(4): 153-157 \nReceived: 02-05-2026 \nAccepted: 05-06-2026 \n \nKP Vasanthakumari \nProfessor, Department of \nObstetrics and Gynaecology, \nSree Mookambika Institute of \nMedical Sciences, \nKanyakumari, Tamil Nadu, \nIndia \n \nElamathi P \nJunior Resident, Department of \nObstetrics and Gynaecology, \nSree Mookambika Institute of \nMedical Sciences, \nKanyakumari, Tamil Nadu, \nIndia \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nElamathi P \nJunior Resident, Department of \nObstetrics and Gynaecology, \nSree Mookambika Institute of \nMedical Sciences, \nKanyakumari, Tamil Nadu, \nIndia \n \nImpact of structured lifestyle interventions on clinical, \nmetabolic, and reproductive outcomes in women with \nendometriosis \n \nKP Vasanthakumari and Elamathi P \n \nDOI: https://www.doi.org/10.33545/gynae.2026.v10.i4c.2496 \n \nAbstract \nBackground: Endometriosis is a chronic gynecological disorder associated with pelvic pain, infertility, \nmetabolic disturbances, and impaired quality of life. Lifestyle factors such as diet, physical activity, obesity, \nand stress have been implicated in the progression and severity of endometriosis. Lifestyle modification may \noffer a cost-effective adjunctive approach in improving both metabolic and reproductive outcomes in affected \nwomen. \nAim: To evaluate the effect of lifestyle modifications on metabolic a nd reproductive outcomes among \nwomen with endometriosis. \nMaterials and Methods: This prospective interventional study was conducted among 50 women aged 18 -\n40 years diagnosed with endometriosis at a tertiary care center. Participants underwent a structured six-month \nlifestyle modification program including dietary counseling, physical activity, weight management, stress \nreduction, and behavioral counseling. Baseline and post -intervention assessments included anthropometric \nmeasurements, fasting blood glucose, lipid profile, insulin resistance, menstrual characteristics, pain severity \nusing Visual Analogue Scale (VAS), and quality of life using Endometriosis Health Profile -30 (EHP-30). \nStatistical analysis was performed using paired ttest and chi-square test, with p<0.05 considered statistically \nsignificant. \nResults: Significant reductions were observed in body weight, body mass index, waist circumference, fasting \nblood glucose, triglyceride levels, and HOMA -IR scores following intervention ( p<0.05). Reproducti ve \noutcomes also improved significantly, including menstrual regularity, ovulatory cycles, dysmenorrhea, \ndyspareunia, and chronic pelvic pain. Mean dysmenorrhea VAS score decreased from 7.8±1.2tan4.3±1.5 \n(p<0.001). Quality of life scores improved significantly after lifestyle modification. \nConclusion: Lifestyle modification significantly improved metabolic health, reproductive outcomes, \nsymptom severity, and quality of life among women with endometriosis. Incorporating structured lifestyle \ninterventions may serve as an effective adjunct in endometriosis management. \n \nKeywords: Endometriosis, lifestyle modification, metabolic outcomes, reproductive health, dysmenorrhea, \nquality of life, insulin resistance, infertility \n \nIntroduction \nEndometriosis is a chronic estrogen-dependent inflammatory disorder characterized by the \npresence of endometrial -like tissue outside the uterine cavity, most commonly involving the \novaries, pelvic peritoneum, uterosacral ligaments, and pouch of Douglas. The disease is associated \nwith dysmenorrhea, chronic pelvic pain, dyspareunia, infertility, menstrual irregularities, and \nreduced quality of life. Although the exact pathogenesis remains unclear, retrograde menstruation, \nimmune dysfunction, genetic predisposition, oxidative stress, an d chronic inflammation are \nconsidered important contributing mechanisms. Endometriosis has a significant impact on \nphysical, psychological, reproductive, and social well-being among affected women[1]. \nGlobally, endometriosis affects approximately 10% of women of reproductive age and nearly 30-\n50% of women presenting with infertility or chronic pelvic pain [2].The prevalence is believed to \nbe underestimated due to delayed diagnosis, variable clinical presentation, and limited awareness. \nIn India, increasing incidence has been reported among young women, particularly those with \nsedentary lifestyle patterns, obesity, dietary imbalance, and stressrelated disorders [3]. Emerging \nevidence suggests that endometriosis is not merely a localized gynecological disease but may also \nbe associated with systemic metabolic alterations  including insulin resistance, dyslipidemia, \nincreased inflammatory markers, and altered body composition [4]. \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n \n154 \nConventional treatment modalities for endometriosis include \nhormonal suppression, analgesics, and surgical management. \nHowever, recurrence of symptoms and persistent impairment in \nquality of life remain major concerns despite treatment. Recent \nresearch has focused on the role of modifiable lifestyle factors \nin the pathophysiology and management of endometriosis. \nDietary habits rich in omega -3 fatty acids, antioxidants, fruits, \nand vegetables have been shown to reduce inflammator y \nresponses, whereas high intake of red meat, trans fats, and \nprocessed foods may worsen disease severity [5]. Regular \nphysical activity has also been associated with reduced estrogen \nlevels, improved insulin sensitivity, weight reduction, and \ndecreased pelvic pain [6]. Stress management and behavioral \ninterventions may further contribute to symptomatic \nimprovement and enhanced psychological well-being. \nPrevious studies have demonstrated promising benefi ts of \nlifestyle interventions in women with endometriosis. Parazzini \net al. reported that increased consumption of green vegetables \nand fruits was associated with a lower risk of endometriosis, \nwhile high red meat intake increased disease risk [7]. Bonocher \net al . observed that physical exercise and antiinflammatory \ndietary modifications significantly reduced pain severity and \nimproved quality of life in affected women [8]. Similarly, \nRahman et al . highlighted the role of obesity and metabolic \ndysfunction in aggravating inflammatory pathways associated \nwith endometriosis progression [9]. Despite growing evidence, \nthere remains limited prospective data evaluating the combined \nimpact of structured lifestyle modification on both metabolic \nand reproductive outcomes in women with endometriosis, \nparticularly in the Indian population. \nConsidering the chronic nature of the disease, the limitations of \nconventional therapies, and the increasing burden of metabolic \nabnormalities among reproductive -age women, evaluation of \nlifestyle modification as an adjunctive therapeutic approach is \nclinically relevant [10]. This study was therefore undertaken to \nassess the effe ct of lifestyle modifications on metabolic \nparameters, reproductive outcomes, symptom severity, and \nquality of life among women diagnosed with endometriosis. \n \nAim and Objectives \nAim \nTo evaluate the effect of lifestyle modifications on metabolic \nand reprodu ctive outcomes among women diagnosed with \nendometriosis. \n \nObjectives \n1. To assess the changes in metabolic parameters (BMI, waist \ncircumference, lipid profile, fasting blood glucose, and \ninsulin resistance) following lifestyle modification among \nwomen with endometriosis. \n2. To evaluate the effect of lifestyle modification on \nreproductive outcomes including menstrual regularity, pain \nseverity, ovulatory function, and fertility status in women \nwith endometriosis. \n3. To determine the association between adherence to \nlifestyle interventions and improvement in quality of life \nand symptom severity among women with endometriosis. \n \nMaterials and Methods \nStudy Design \nThis study was designed as a hospital -based prospective \ninterventional study conducted to evaluate the effect of lifestyle \nmodifications on metabolic and reproductive outcomes among \nwomen diagnosed with endometriosis. \nStudy Setting \nThe study was carried out in the Department of Obstetrics and \nGynaecology at a tertiary care teaching hospital over a period \nof 12 mo nths after obtaining approval from the Institutional \nEthics Committee. \n \nStudy Population \nWomen diagnosed with endometriosis attending the \ngynecology outpatient department and infertility clinic were \nincluded in the study. \n \nInclusion Criteria \n Women aged between 18 and 40 years \n Diagnosed cases of endometriosis confirmed clinically, \nultrasonographically, laparoscopically, or \nhistopathologically \n Women willing to participate and provide informed written \nconsent \n Patients willing to adhere to lifestyle modificatio n \nprotocols and follow-up visits \n \nExclusion Criteria \n Pregnant women \n Women with malignancy or severe systemic illness \n Patients with endocrine disorders such as uncontrolled \ndiabetes mellitus, thyroid disorders, Cushing syndrome, or \npolycystic ovarian syndrome \n Women receiving hormonal therapy during the previous \nthree months \n Patients with psychiatric illness or inability to comply with \nfollow-up \n \nSample Size Calculation \nThe sample size was calculated using the formula for \ncomparison of means in interventional studies: \n \n𝑛 = (𝑍𝛼/2 + 𝑍𝛽)2 × 2𝜎2\n𝑑2  \n \nWhere: \n 𝑛= required sample size  \n 𝑍𝛼/2= 1.96 corresponding to 95% confidence interval  \n 𝑍𝛽= 0.84 corresponding to 80% study power  \n 𝜎= standard deviation of pain score from previous study  \n 𝑑= expected mean difference after intervention \n \nBased on a previous study by Yela DA et al., the expected \nreduction in pain score following lifestyle intervention was \n1.5 with a standard deviation of 2.5. \n \nSubstituting the values \n \n𝑛 = (1.96 + 0.84)2 × 2 × (2.5)2\n(1.5)2  \n \n𝑛 = 7.84 × 12.5\n2.25  \n \n𝑛 = 43.5 \n \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n \n155 \nThe minimum required sample size was calculated to be 44 \nparticipants. Considering a 10% attrition rate due to possible \nloss to follow -up, the final sample size was rounded to 50 \nparticipants. \n \nSampling Technique \nEligible participants fulfilling the inclusion criteria were \nrecruited using consecutive sampling until the required sample \nsize was achieved. \n \nStudy Procedure \nAfter obtaining written informed consent, detailed demographic \nand clinical information was collected u sing a predesigned \nstructured proforma. \n \nBaseline Assessment \nThe following baseline parameters were recorded: \n \n1. Sociodemographic Data \n Age \n Marital status \n Educational status \n Occupation \n Socioeconomic status \n \n2. Clinical Parameters \n Duration of symptoms \n Menstrual history \n Dysmenorrhea severity \n Dyspareunia \n Chronic pelvic pain \n Infertility history \n Obstetric history \n Family history of endometriosis \n \n3. Anthropometric Measurements \n Height \n Weight \n Body mass index (BMI) \n Waist circumference \n Hip circumference \n Waist-hip ratio \n \n4. Metabolic Assessment \n Fasting blood glucose \n Serum insulin \n Lipid profile \n Homeostatic Model Assessment for Insulin Resistance \n(HOMA-IR) \n \n5. Reproductive Assessment \n Menstrual cycle regularity \n Ovulatory status \n Fertility status \n Ultrasonographic findings \n Severity of endometriosis-related symptoms \n \n6. Pain Assessment \nPain severity was assessed using the Visual Analogue Scale \n(VAS) for: \n Dysmenorrhea \n Chronic pelvic pain \n Dyspareunia \n7. Quality of Life Assessment \nQuality of life was evaluated using the Endometri osis Health \nProfile questionnaire (EHP-30). \n \nLifestyle Modification Intervention \nAll participants underwent a structured lifestyle modification \nprogram for six months, which included: \n \nDietary Modification \nParticipants received dietary counseling focusing on: \n Increased intake of fruits, vegetables, whole grains, and \nomega-3-rich foods \n Reduction in processed foods, red meat, refined sugars, and \nsaturated fats \n Adequate hydration and balanced calorie intake \n \nPhysical Activity \nParticipants were advised: \n Moderate aerobic exercise for at least 150 minutes per \nweek \n Yoga and stretching exercises \n Regular walking and strengthening exercises \n \nStress Reduction Measures \n Sleep hygiene counseling \n Meditation and relaxation techniques \n Stress management education \n \nBehavioral Counseling \nPeriodic counseling sessions were conducted to improve \nadherence to healthy lifestyle practices. \n \nFollow-Up \nParticipants were followed up monthly for six months. During \neach follow-up visit: \n Compliance with lifestyle modification was assessed \n Anthropometric measurements were repeated \n Symptom severity and pain scores were recorded \n Adverse events, if any, were documented \n \nAt the end of six months, metabolic and reproductive \nparameters were reassessed and compared with baseline \nfindings. \n \nOutcome Measures \nPrimary Outcomes \n Change in BMI and waist circumference \n Change in fasting blood glucose and lipid profile \n Reduction in pain scores \n \nSecondary Outcomes \n Improvement in menstrual regularity \n Improvement in fertility status \n Improvement in quality of life scores \n Reduction in symptom severity \n \nStatistical Analysis \nData were entered into Microsoft Excel and analyzed using \nStatistical Package for Social Sciences (SPSS) version 26.0. \nContinuous variables were expressed as mean ± standard \ndeviation, while catego rical variables were presented as \nfrequency and percentage. \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n \n156 \n Paired t-test was used to compare pre - and post -\nintervention continuous variables. \n Chi-square test was used for categorical variables. \n Pearson correlation analysis was performed to assess \nassociations between adherence and clinical improvement. \n A p-value of less than 0.05 was considered statistically \nsignificant. \n \nEthical Considerations \nInstitutional Ethics Committee approval was obtained prior to \ncommencement of the study. Written informed consent  was \nobtained from all participants. Confidentiality of patient \ninformation was strictly maintained throughout the study. \n \nResults \nA total of 50 women diagnosed with endometriosis were \nincluded in the study and completed the six -month lifestyle \nmodification program. The effects of lifestyle intervention on \nmetabolic and reproductive outcomes were analyzed. \n \nTable 1: Baseline Sociodemographic and Clinical Characteristics of \nStudy Participants (n = 50) \n \nVariable Frequency (n) Percentage (%) \nAge Group (years)   \n18-25 12 24.0 \n26-30 18 36.0 \n31-35 14 28.0 \n36-40 6 12.0 \nMarital Status   \nMarried 38 76.0 \nUnmarried 12 24.0 \nBody Mass Index   \nNormal (18.5-24.9 kg/m2) 17 34.0 \nOverweight (25-29.9 kg/m2) 23 46.0 \nObese (≥30 kg/m2) 10 20.0 \nPresenting Symptoms   \nDysmenorrhea 44 88.0 \nChronic pelvic pain 32 64.0 \nDyspareunia 21 42.0 \nInfertility 19 38.0 \nMenstrual irregularity 28 56.0 \n \nTable 2: Comparison of Anthropometric and Metabolic Parameters Before and After Lifestyle Modification (n = 50) \n \nParameter BaselineMean ± SD Post-interventionMean ± SD MeanDifference p-value \nBody weight (kg) 69.4 ± 8.2 64.8 ± 7.5 4.6 <0.001 \nBMI (kg/m2) 28.1 ± 3.4 25.9 ± 3.1 2.2 <0.001 \nWaist circumference (cm) 91.6 ± 7.8 86.3 ± 6.9 5.3 <0.001 \nFasting blood glucose (mg/dL) 102.4 ± 14.1 94.7 ± 10.3 7.7 0.002 \nSerum triglycerides (mg/dL) 168.5 ± 28.6 148.2 ± 24.1 20.3 <0.001 \nHOMA-IR 3.1 ± 0.8 2.4 ± 0.6 0.7 0.001 \n \nTable 3: Comparison of Reproductive Outcomes Before and After Lifestyle Modification (n = 50) \n \nReproductive Parameter Baseline n (%) Post-intervention n (%) p-value \nRegular menstrual cycles 22 (44.0) 37 (74.0) 0.003 \nOvulatory cycles 26 (52.0) 39 (78.0) 0.006 \nInfertility 19 (38.0) 12 (24.0) 0.041 \nDysmenorrhea 44 (88.0) 23 (46.0) <0.001 \nDyspareunia 21 (42.0) 11 (22.0) 0.028 \nChronic pelvic pain 32 (64.0) 16 (32.0) 0.002 \n \nTable 4: Comparison of Pain Scores and Quality of Life Before and After Lifestyle Modification (n = 50) \n \nParameter Baseline Mean ± SD Post-intervention Mean ± SD p-value \nDysmenorrhea VAS score 7.8 ± 1.2 4.3 ± 1.5 <0.001 \nPelvic pain VAS score 6.9 ± 1.4 3.8 ± 1.3 <0.001 \nDyspareunia VAS score 5.8 ± 1.6 3.1 ± 1.2 <0.001 \nEHP-30 quality of life score 61.4 ± 9.7 38.6 ± 8.4 <0.001 \n \nTable 5: Association Between Adherence to Lifestyle Modification and Clinical Improvement (n = 50) \n \nAdherence Level Significant Symptom Improvement n (%) No Significant Improvement n (%) Total p-value \nGood adherence 24 (88.9) 3 (11.1) 27 0.001 \nModerate adherence 11 (64.7) 6 (35.3) 17  \nPoor adherence 2 (33.3) 4 (66.7) 6  \n \nDiscussion \nThe present prospective interventional study evaluated the \neffect of lifestyle modifications on metabolic and reproductive \noutcomes among women with endometriosis. The study \ndemonstrated significant improvement in anthropometric \nindices, metabolic p arameters, reproductive health, pain \nseverity, and quality of life following a structured six -month \nlifestyle intervention program. \nIn the present study, the majority of participants belonged to the \nage group of 26 -30 years, and dysmenorrhea was the most \ncommon presenting complaint, observed in 88% of cases. \nSimilar findings were reported by Parazzini et al., who observed \nthat endometriosis predominantly affects women in the \nreproductive age group and commonly presents with \ndysmenorrhea and chronic pelvic p ain[7]. The high prevalence \nof overweight and obesity among study participants further \nsupports the association between metabolic dysfunction and \nendometriosis progression. \nSignificant reductions in body weight, BMI, waist \ncircumference, fasting blood glucose, triglyceride levels, and \nHOMA-IR scores were observed after lifestyle intervention in \nthe current study. These findings are consistent with the \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n \n157 \nobservations of Rahman et al., who demonstrated that increased \nbody adiposity a nd metabolic imbalance contribute to \ninflammatory activity and disease severity in endometriosis [9]. \nSimilarly, Nirgianakis et al. reported that dietary modification \nand physical activity improved metabolic parameters and \nreduced systemic inflammation among women with \nendometriosis[5]. The reduction in insulin resistance observed in \nthe present study may be attributed to regular physical activity, \nimproved dietary habits, and weight reduction achieved during \nfollow-up. \nThe present study also showed significant improvement in \nreproductive outcomes, including menstrual regularity, \novulatory cycles, and reduction in infertility-related complaints. \nComparable results were observed by Tennfjord et al ., who \nreported that regular exercise and healthy lifestyle practices \npositively influenced reproductive hormone regulation and \nmenstrual function in women with endometriosis [6]. Improved \novulatory function may be related to decreased chronic \ninflammation and improved metabolic homeostasis following \nintervention. \nPain reduction was one of the major findings of this study. \nSignificant decreases in dysmenorrhea, dyspareunia, and \nchronic pelvic pain scores were noted after six months of \nlifestyle modification. These results are in agreement with \nBonocher et al., who demonstrated that physical exercise and \nanti-inflammatory dietary interventions reduced pelvic pain \nintensity and improved symptom control in women with \nendometriosis[8]. Physical activity is believed to reduce \ncirculating estrogen levels and inflammatory mediators, thereby \ncontributing to symptom improvement. \nQuality of life scores also improved significantly in the present \nstudy following intervention. Similar findings were reported by \nArmour et al ., who observed that lifestyle -based \nselfmanagement strategies including exercise, dietary \nregulation, and stress reduction improved psychological well -\nbeing and overall quality of life among women with \nendometriosis[11]. The improvement in quality of life observed \nin the current study may be secondary to reduction in pain \nseverity, better menstrual health, and enhanced physical fitness. \nAn important observation in the present stu dy was the \nsignificant association between adherence to lifestyle \nmodification and clinical improvement. Participants with better \nadherence demonstrated greater symptomatic relief and \nmetabolic improvement compared to those with poor \nadherence. This finding highlights the importance of sustained \nbehavioral changes and patient motivation in long-term disease \nmanagement. \nOverall, the findings of the present study support the growing \nevidence that lifestyle modification serves as an effective \nadjunctive strate gy in the management of endometriosis. \nStructured interventions focusing on healthy diet, physical \nactivity, weight management, and stress reduction may improve \nboth metabolic and reproductive outcomes while reducing \nsymptom burden and enhancing quality of life. \n \nLimitations \nThe study was limited by its relatively small sample size and \nshort duration of follow -up, which may restrict generalization \nof the findings. Being a single-center study, regional variations \nin lifestyle and disease characteristics could not be assessed. In \naddition, adherence to lifestyle modifications was partially \ndependent on self -reporting, which may introduce reporting \nbias. Further multicentric studies with larger sample sizes and \nlong-term follow-up are recommended to validate the findings. \nConclusion \nThe present study demonstrated that structured lifestyle \nmodification significantly improved metabolic parameters, \nreproductive outcomes, pain severity, and quality of life among \nwomen with endometriosis. Reduction in body weight, i nsulin \nresistance, dysmenorrhea, chronic pelvic pain, and menstrual \nirregularities was observed following dietary regulation, \nphysical activity, and stress management interventions. \nLifestyle modification may therefore serve as an effective, low-\ncost, and non-pharmacological adjunct in the comprehensive \nmanagement of endometriosis. \n \nReferences \n1. Williams Gynecology, Fourth Edition eBook : Hoffman, \nBarbara L., Schorge, John O., Bradshaw, Karen D., \nHalvorson, Lisa M., Schaffer, Joseph I., Corton, Marlene \nM.: Amazon.co.uk: Books [Internet]. 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Endometriosis is a \nchronic systemic disease: clinical challenges and novel \ninnovations. Lancet. 2021;397(10276):839 -\n52.https://doi.org/10.1016/S0140-6736(21)00389-5 \n11. Armour M, Sinclair J, Chalmers KJ, Smith CA. Self -\nmanagement strategies amongst Australian women with \nendometriosis: a national online survey. BMC Complement \nAltern Med. \n2019;19(1):17.https://doi.org/10.1186/s12906-019-2431-x","source_license":"CC0","license_restricted":false}