{"paper_id":"900a6387-2fd9-4c2d-8953-44a8844b823d","body_text":"Clin. Exp. Obstet. Gynecol. 2026; 53(3): 47529\nhttps://doi.org/10.31083/CEOG47529\nCopyright: © 2026 The Author(s). Published by IMR Press.\nThis is an open access article under the CC BY 4.0 license .\nPublisher’s Note: IMR Press stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nOriginal Research\nEffect of Endometriosis on Women’s Daily Functioning, Emotional\nWell-Being, and Quality of Life: A Cross-Sectional Study\nEmilia Mondrzik1,†, Katarzyna Wszołek 1, Marcin Wierzchowski2, Maciej Wilczak1,\nKarolina Chmaj-Wierzchowska1,*,†\n1Department of Maternal and Child Health and Minimally Invasive Surgery, Poznan University of Medical Sciences, 61-701 Poznan, Poland\n2Chair and Department of Chemical Technology of Drugs, Poznan University of Medical Sciences, 61-701 Poznan, Poland\n*Correspondence: karolinachmaj@poczta.onet.pl (Karolina Chmaj-Wierzchowska)\n†These authors contributed equally.\nAcademic Editor: Michael H. Dahan\nSubmitted: 21 October 2025 Revised: 7 December 2025 Accepted: 25 December 2025 Published: 23 March 2026\nAbstract\nBackground: Endometriosis may have diverse impacts on patients’ quality of life due to the heterogeneity of its symptoms. The aim\nof this study was to assess the impact of endometriosis on quality of life based on determinants such as age, education level, place\nof residence, parenthood status, current disease stage, and disease duration. Methods: This study included 100 Polish women with\nendometriosis. The research tool used to assess the impact of endometriosis on women’s quality of life was a newly developed, non-\nvalidated questionnaire, administered electronically via Google Forms and distributed through social networks and support groups for\nwomen with endometriosis. Results: Women under 30 years of age (p < 0.001), without children (p < 0.001), with stage I endometriosis\n(p = 0.03), and those who had suffered from the disease for less than 5 years ( p = 0.001) were significantly more likely to report no\ndifficulty conceiving due to endometriosis. Most women (42%) assessed their quality of life as “positive”, with 38% reporting it as\n“good” and 4% as “very good”. However, 40% of respondents indicated that their quality of life was “neither good nor bad”. Only 16%\nof reported “poor” quality of life, and 2% reported “very poor” quality of life. Conclusions: Endometriosis is a condition that affects\nall aspects of a woman’s life. Our findings indicate that its negative effects are complex and multidimensional, with most participants\nreporting sadness and depressive feelings rather than happiness, and nearly half reporting dissatisfaction with their sleep quality. Although\nvalidated instruments offer greater objectivity, they are often time consuming. Non-validated instruments, such as global assessments,\nare easier to administer but may be more subjective.\nKeywords: endometriosis; quality of life; pain\n1. Introduction\nEndometriosis is a chronic, inflammatory, estrogen-\ndependent disease. Its hallmarks are the presence of active\nepithelium and/or endometrium-like lining outside the uter-\nine cavity [ 1,2]. The severity and clinical presentation of\nendometriosis vary widely. The most common foci are in\nthe ovaries, fallopian tubes, rectouterine pouch (pouch of\nDouglas), and abdominal peritoneum. In cases of deeply\ninfiltrating endometriosis, lesions may also develop in the\nbladder, intestines, and subperitoneum. Less commonly,\nthey occur in locations such as the diaphragm and lungs\n[3,4].\nEndometriosis is estimated to affect 10–15% of\nwomen of reproductive age and 2–5% of postmenopausal\nwomen, representing approximately 176 million women\nworldwide [ 5–9]. It is detected in up to 50% of women\nundergoing infertility treatment [ 5]. The symptoms of en-\ndometriosis are varied and non-specific; hence, they are\noften mistaken with symptoms of other conditions. The\nmost commonly reported symptoms include painful men-\nstruation, heavy or irregular menstrual bleeding, and pelvic\npain [1]. The condition may also be accompanied by pain\nduring intercourse, pain or bleeding during urination and\ndefecation, painful rectal bleeding, infertility, cyclic chest\npain, coughing, or hemoptysis [ 2,4]. However, endometri-\notic lesions do not always produce clinical symptoms [ 5].\nOne of the challenges in diagnosing endometriosis is its un-\ndetermined etiopathology [10–13]. Due to the complex na-\nture of its symptoms and the lack of specific biomarkers,\nthe average time to diagnosis is 9.6 years [14], significantly\nimpacting the quality of life of affected women [ 11–13,15].\nChronic pain, discomfort, and other symptoms sig-\nnificantly limit patients’ daily functioning, affecting their\nprofessional activities, social and family relationships, and\nemotional well-being [ 11–13]. Several validated tools\nare available to assess the quality of life of women with\nendometriosis across various domains: Short Form 36\n(SF-36), Short Form 12 (SF-12), Nottingham Health Pro-\nfile (NHP), World Health Organization Quality of Life\nAssessment-BREF (WHOQOL-BREF), and Endometriosis\nHealth Profile-30 (EHP-30) [ 16–20]. Therefore, this study\naimed to assess the impact of endometriosis on the qual-\nity of life of Polish women, based on determinants identi-\nfied through a comprehensive literature review: age, educa-\n\nTable 1. Demographic characteristics of the study group.\nn = 100 (%)\nAge <30 years 50\n≥30 years 50\nEducation levels\nPrimary 1\nV ocational 8\nSecondary 27\nHigher 64\nPlace of residence\nRural 25\nCity with population <10 thousand 18\nCity with population of 10–100 thousand 23\nCity with population of 100–500 thousand 14\nCity with population >500 thousand 20\nMarital status\nMarriage 47\nPartnership 31\nNot in a partnership/marriage 22\nProfessional activity Working 89\nNot working 11\nParenthood\nNo children 64\nHas children 34\nCurrently pregnant 2\ntion, place of residence, parenthood, current disease stage,\nand disease duration. Considering the high variability and\nseverity of endometriosis symptoms across different pop-\nulations, the use of a newly developed questionnaire may\nenable the identification of previously unrecognized factors\nthat influence the quality of life of women with endometrio-\nsis in Poland.\n2. Materials and Methods\nThis study was conducted in a cohort of 100 Polish\nwomen with endometriosis. Participants voluntarily com-\npleted the questionnaire after being informed that their re-\nsponses would remain anonymous and used exclusively\nfor scientific purposes. The study was conducted between\nApril and October 2023. The inclusion criteria included fe-\nmale sex and a confirmed diagnosis of endometriosis.\nThe research tool used to assess the impact of en-\ndometriosis on women’s quality of life was a newly de-\nveloped, unvalidated questionnaire. The questionnaire was\nwritten in colloquial language understandable to all patients\nand was administered electronically via Google Forms ( ht\ntps://forms.gle/QgygjJjU4x5wAvB37). It was distributed\nthrough social networks and support groups for women with\nendometriosis. Participation was voluntary, anonymous,\nand conducted entirely online. The use of an unvalidated\ninstrument may limit the generalizability and comparability\nof the findings with those of studies that use standardized\nQuality of Life (QoL) measures. This limitation is acknowl-\nedged in the Discussion section and should be considered\nwhen interpreting the results.\nRespondents answered closed-ended questions, in-\ncluding single-choice and multiple-choice items, including\none question that allowed a typed response for age. The first\nsection of the questionnaire collected basic demographic in-\nformation, including age, marital status, place of residence,\neducation level, and type of work performed. The subse-\nquent section gathered information on disease stage (stage I,\nII, III, or IV; this was not subject to secondary verification),\ndisease duration (1–5 years, 6–10 years, or >10 years) and\nany accompanying pain symptoms.\nThe final section of the survey included specific ques-\ntions designed to assess quality of life. The study exam-\nined various aspects of daily life, including concomitant\nsymptoms and complaints, treatment methods and their ef-\nfectiveness, fertility and pregnancy complications, daily ac-\ntivities, physical activity, professional work, financial diffi-\nculties, sexual life, sleep, relationships with loved ones, ful-\nfillment of plans/dreams/goals, fatigue, as well as positive\nand negative emotions. A comparative analysis of the re-\nspondents was conducted based on age, education, place of\nresidence, parenthood status, disease severity classification,\nand disease duration. Correlations between variables were\ntested using the Chi-square ( χ2) test. This test compares\nthe observed frequencies with the frequencies expected un-\nder the assumption of independence, helping to test whether\nthe two variables are associated. Data analysis was per-\nformed using Statistica (Cloud Software Group, Inc., 2023;\nFort Lauderdale, FL, USA, version 14), and Microsoft Ex-\ncel (Microsoft Office 2019; Redmond, W A, USA, version\n2025). A p < 0.05 was considered statistically significant.\n2\n\n\nTable 2. Endometriosis stage and duration in the study\npopulation.\nEndometriosis Stage and time n = 100 (%)\nStage of endometriosis at\nthe time of diagnosis\nStage I 35\nStage II 30\nStage III 22\nStage IV 13\nCurrent stage of endometriosis\nStage I 37\nStage II 33\nStage III 20\nStage IV 10\nDuration of disease\n1–5 years 66\n5–10 years 14\nOver 10 years 20\n3. Results\nThe study group consisted of women with endometrio-\nsis aged 18 to 55 years.\n3.1 Characteristics of the Study Group\nMost of the participants ranged between 20 and 30\nyears old, with a mean age of 29.5 years ( ±7.99). Regard-\ning education, the largest proportion (64%) had completed\nhigher education, followed by those with secondary educa-\ntion (27%). Among the respondents, 25% resided in rural\nareas, while the majority (75%) resided in urban areas. In\nterms of marital status, 47% were married, 31% were in\na civil partnership, and 22% were single, indicating they\nwere not in a partnership or marriage. The response op-\ntion “widow” was included, but no respondents selected it.\nParticipants were asked about their professional activities.\nThe majority (89%) reported they were professionally ac-\ntive, while 11% indicated they did not work. In the study\ngroup, 64% of women had no children, 34% had children,\nand 2% were currently pregnant. The demographic charac-\nteristics of the study group are presented in Table 1.\n3.2 Endometriosis\nThe majority of respondents (71%) answered “yes” to\nthe question “Before your diagnosis, had you heard about\nthe disease called endometriosis?”. In contrast, 29% of\nwomen were unaware of the condition prior to their diagno-\nsis. At the time of diagnosis, 65% of respondents had less\nadvanced endometriosis: 35% were in stage I and 30% were\nin stage II. Stage III endometriosis was observed in 22%\nof patients, and 13% were diagnosed with stage IV disease.\nWhen asked about their current stage of endometriosis, 37%\nof respondents reported stage I, 33% reported stage II, 20%\nreported stage III, and 10% reported stage IV . The dura-\ntion of the disease varied among respondents. The majority\n(66%) had experienced the disease for 1–5 years, 14% for\n5–10 years, and 20% for more than 10 years. Information\non the stage of endometriosis at the time of diagnosis, the\ncurrent stage, and the duration of the disease are presented\nin Table 2.\nOccurrence of Endometriosis Symptoms\nParticipants were asked about their pain symptoms\nand complaints. The most frequently reported symp-\ntom was severe lower abdominal pain during menstrua-\ntion (81%). More than half of the respondents experienced\nlower back pain (65%) and pain during intercourse (62%).\nLess commonly reported symptoms included pain during\nbowel movements (44%), sciatica-like pain (35%), and pain\nduring urination (14%).\nIndividuals over 30 years of age were significantly\nmore likely to report pain during bowel movements ( p =\n0.02) and constipation ( p = 0.01). Those with lower edu-\ncation levels were more likely to report pain during urina-\ntion ( p = 0.02) and defecation ( p = 0.003). Women from\nsmaller towns were significantly more likely to report pain\nduring intercourse (p = 0.01), while others more frequently\nreported sciatica-like pain ( p = 0.03).\nWomen without children more frequently reported se-\nvere lower abdominal pain during menstruation ( p = 0.001)\nand during urination ( p = 0.01). Fewer respondents with\nstage I disease reported pain during defecation ( p = 0.01).\n3.3 Effect of Endometriosis on Women’ s Daily Functioning\n3.3.1 Have Y ou Had any Problems Conceiving That Could\nHave Been Caused by Endometriosis?\nInfertility due to endometriosis was reported by 42%\nof the women, while 20% reported no problem conceiving,\nand 38% had no plans to become pregnant. Women under\n30 years of age ( p < 0.001), without children ( p < 0.001),\nwith stage I endometriosis ( p = 0.03), and those who had\nsuffered from the disease for less than 5 years ( p = 0.001)\nwere significantly more likely to report no difficulty con-\nceiving due to endometriosis. Correlations between “Prob-\nlems conceiving due to endometriosis” and variables in-\ncluding age, education, place of residence, parity, disease\nstage, and disease duration are presented in Table 3.\n3.3.2 Do Y ou Experience a Lack of Societal Acceptance\ndue to Infertility?\nRespondents were asked whether they experienced\na lack of societal acceptance due to infertility: 47% an-\nswered “not at all”, 22% answered “somewhat”, 17% an-\nswered “moderately”, 9% answered “very much”, and 3%\nanswered “fully”. The analysis demonstrated that women\nwithout children reported significantly higher levels of per-\nceived societal lack of acceptance due to infertility ( p =\n0.03). Correlations between “Perceived societal lack of\nacceptance due to infertility” and study variables are pre-\nsented in Table 4.\n3\n\nTable 3. Correlations between “Problems conceiving due to endometriosis” and study variables.\nProblems conceiving due to endometriosis χ² p-value\nY es No Not applicable\nI. Age <30 years 13 (26%) 6 (12%) 31 (62%) 25.92 <0.001≥30 years 29 (58%) 14 (28%) 7 (14%)\nII. Education levels Higher 29 (45.31%) 11 (17.19%) 24 (37.50%) 1.17 0.56Other 13 (36.11%) 9 (25.00%) 14 (38.89%)\nIII. Place of residence <10,000 23 (53.49%) 8 (18.60%) 12 (27.91%) 4.5 0.11≥10,000 19 (33.33%) 12 (21.05%) 26 (45.61%)\nIV . Parenthood (n = 98) Y es 10 (29.41%) 19 (55.88%) 5 (14.71%) 44 <0.001No 30 (46.88%) 1 (1.56%) 33 (51.56%)\nV . Current stage of endometriosis\nI 10 (27.03%) 6 (16.22%) 21 (56.76%)\n11.04 0.03II 18 (54.55%) 5 (15.15%) 10 (30.30%)\nIII/IV 14 (46.67%) 9 (30.00%) 7 (23.33%)\nVI. Duration of disease <5 years 21 (31.82%) 12 (18.18%) 33 (50.00%) 13.47 0.001≥5 years 21 (61.76%) 8 (23.53%) 5 (14.71%)\nTable 4. Correlations between “Perceived societal lack of acceptance due to the infertility” and study variables.\nPerceived societal lack of acceptance due to infertility χ² p-value\n“Not at all” “Somewhat” “Moderately” “V ery much” “Fully”\nI. Age <30 years 7 (14%) 19 (38%) 6 (12%) 16 (32%) 2 (4%) 3.59 0.46≥30 years 8 (16%) 12 (24%) 9 (18%) 16 (32%) 5 (10%)\nII. Education levels Higher 9 (14.06%) 22 (34.38%) 9 (14.06%) 20 (31.25%) 4 (6.25%) 1.05 0.90Other 6 (16.67%) 9 (25.00%) 6 (16.67%) 12 (33.33%) 3 (8.33%)\nIII. Place of residence <10,000 5 (11.63%) 18 (41.86%) 3 (6.98%) 14 (32.56%) 3 (6.98%) 6.97 0.14≥10,000 10 (17.54%) 13 (22.81%) 12 (21.05%) 18 (31.58%) 4 (7.02%)\nIV . Parenthood (n = 98) Y es 10 (29.41%) 7 (20.59%) 7 (20.59%) 8 (23.53%) 2 (5.88%) 11.12 0.03No 5 (7.81%) 24 (37.50%) 7 (10.94%) 23 (35.94%) 5 (7.81%)\nV . Current stage of endometriosis\nI 6 (16.22%) 11 (29.73%) 7 (18.92%) 10 (27.03%) 3 (8.11%)\n3.94 0.86II 3 (9.09%) 13 (39.39%) 4 (12.12%) 11 (33.33%) 2 (6.06%)\nIII/IV 6 (20.00%) 7 (23.33%) 4 (13.33%) 11 (36.67%) 2 (6.67%)\nVI. Duration of disease <5 years 10 (15.15%) 23 (34.85%) 9 (13.64%) 20 (30.30%) 4 (6.06%) 1.62 0.81≥5 years 5 (14.71%) 8 (23.53%) 6 (17.65%) 12 (35.29%) 3 (8.82%)\n3.3.3 Does Y our Health Condition Prevent Y ou From\nPerforming Daily Activities?\nRegarding the impact of endometriosis on daily ac-\ntivities, 47% of respondents indicated that endometriosis\n“somewhat” affected their ability to perform activities of\ndaily living. In comparison, 16%, 10%, 22%, and 5% of\nthe respondents answered “not at all”, “moderately”, “very\nmuch”, and “fully”, respectively. The study showed that\nwomen over the age of 30 ( p = 0.04) and those with less\neducation (p = 0.01) gave a significantly higher rating for\nthe impact of the condition on performing of daily activities.\nThe correlations between the “Influence of health condition\non activities of daily living” and the study variables are pre-\nsented in Table 5.\n3.3.4 Does Y our Health Condition Prevent Y ou From\nEngaging in Physical Activity?\nRegarding whether endometriosis prevented them\nfrom engaging in physical activity, 15%, 37%, 17%, 29%,\nand 2% of the respondents responded “not at all”, “some-\nwhat”, “moderately”, “very much”, and “fully”, respec-\ntively. In this study, individuals with less education levels\n(p = 0.003) reported a significantly higher impact of en-\ndometriosis on their ability to engage in physical activity.\nThe correlations between the “Influence of health status on\nphysical activity” and the study variables are presented in\nTable 6.\n3.3.5 Does Having the Disease Create Difficulties in\nObtaining a Job?\nParticipants were asked to rate the extent to which\nthe disease interfered with their ability to obtain employ-\n4\n\n\nTable 5. Correlations between “Influence of health condition on activities of daily living” and study variables.\nInfluence of health condition on activities of daily living χ² p-value\n“Not at all” “Somewhat” “Moderately” “V ery much” “Fully”\nI. Age <30 years 10 (20%) 29 (58%) 3 (6%) 6 (12%) 2 (4%) 1.17 0.04≥30 years 6 (12%) 18 (36%) 7 (14%) 16 (32%) 3 (6%)\nII. Education levels Higher 11 (17.19%) 35 (54.69%) 7 (10.94%) 11 (17.19%) 0 (0%) 14.69 0.01Other 5 (13.89%) 12 (33.33%) 3 (8.33%) 11 (30.56%) 5 (13.89%)\nIII. Place of residence <10,000 7 (16.28%) 21 (48.84%) 5 (11.63%) 9 (20.93%) 1 (2.33%) 1.48 0.83≥10,000 9 (15.79%) 26 (45.61%) 5 (8.77%) 13 (22.81%) 4 (7.02%)\nIV . Parenthood (n = 98) Y es 5 (14.71%) 15 (44.12%) 5 (14.71%) 6 (17.65%) 3 (8.82%) 2.84 0.58No 11 (17.19%) 31 (48.44%) 5 (7.81%) 15 (23.44%) 2 (3.13%)\nV . Current stage of endometriosis\nI 7 (18.92%) 18 (48.65%) 2 (5.41%) 9 (24.32%) 1 (2.70%)\n3.44 0.90II 4 (12.12%) 17 (51.52%) 4 (12.12%) 6 (18.18%) 2 (6.06%)\nIII/IV 5 (16.67%) 12 (40.00%) 4 (13.33%) 7 (23.33%) 2 (6.67%)\nVI. Duration of disease <5 years 13 (19.70%) 31 (46.97%) 6 (9.09%) 12 (18.18%) 4 (6.06%) 3.70 0.45≥5 years 3 (8.82%) 16 (47.06%) 4 (11.76%) 10 (29.41%) 1 (2.94%)\nTable 6. Correlations between “Influence of health status on physical activity” and study variables.\nInfluence of health status on physical activity χ² p-value\n“Not at all” “Somewhat” “Moderately” “V ery much” “Fully”\nI. Age <30 years 9 (18%) 24 (48%) 7 (14%) 9 (18%) 1 (2%) 8.74 0.07≥30 years 6 (12%) 13 (26%) 10 (20%) 20 (40%) 1 (2%)\nII. Education levels Higher 11 (17.19%) 31 (48.44%) 10 (15.63%) 11 (17.19%) 1 (1.56%) 16.18 0.003Other 4 (11.11%) 6 (16.67%) 7 (19.44%) 18 (50.00%) 1 (2.78%)\nIII. Place of residence <10,000 8 (18.60%) 15 (34.88%) 5 (11.63%) 15 (34.88%) 0 (0%) 5.21 0.27≥10,000 7 (12.28%) 22 (38.60%) 12 (21.05%) 14 (24.56%) 2 (3.51%)\nIV . Parenthood (n = 98) Y es 7 (20.59%) 11 (32.35%) 6 (17.65%) 10 (29.41%) 0 (0%) 3.21 0.52No 8 (12.50%) 26 (40.63%) 9 (14.06%) 19 (29.69%) 2 (3.13%)\nV . Current stage of endometriosis\nI 7 (18.92%) 14 (37.84%) 7 (18.92%) 9 (24.32%) 0 (0%)\n10.08 0.26II 3 (9.09%) 17 (51.52%) 4 (12.12%) 8 (24.24%) 1 (3.03%)\nIII/IV 5 (16.67%) 6 (20.00%) 6 (20.00%) 12 (40.00%) 1 (3.33%)\nVI. Duration of disease <5 years 11 (16.67%) 28 (42.42%) 7 (10.61%) 19 (28.79%) 1 (1.52%) 6.59 0.16≥5 years 4 (11.76%) 9 (26.47%) 10 (29.41%) 10 (29.41%) 1 (2.94%)\nTable 7. Correlations between “Disease-related difficulty in obtaining a job” and study variables.\nDisease-related difficulty in obtaining a job χ² p-value\n“Not applicable” “Not at all” “A little” “Moderately” “V ery much” “Fully”\nI. Age <30 years 13 (26%) 15 (30%) 11 (22%) 3 (6%) 7 (14%) 1 (2%) 4.06 0.54≥30 years 6 (12%) 18 (36%) 10 (20%) 5 (10%) 9 (18%) 2 (4%)\nII. Education levels Higher 13 (20.31%) 23 (35.94%) 15 (23.44%) 6 (9.38%) 7 (10.94%) 0 (0%) 10.44 0.06Other 6 (16.67%) 10 (27.78%) 6 (16.67%) 2 (5.56%) 9 (25.00%) 3 (8.33%)\nIII. Place of residence <10,000 4 (9.30%) 14 (32.56%) 9 (20.93%) 3 (6.98%) 10 (23.26%) 3 (6.98%) 11.68 0.04≥10,000 15 (26.32%) 19 (33.33%) 12 (21.05%) 5 (8.77%) 6 (10.53%) 0 (0%)\nIV . Parenthood (n = 98) Y es 6 (17.65%) 16 (47.06%) 3 (8.82%) 4 (11.76%) 3 (8.82%) 2 (5.88%) 10.75 0.06No 12 (18.75%) 17 (26.56%) 18 (28.13%) 4 (6.25%) 12 (18.75%) 1 (1.56%)\nV . Current stage of\nendometriosis\nI 10 (27.03%) 10 (27.03%) 7 (18.92%) 2 (5.41%) 6 (16.22%) 2 (5.41%)\n9.44 0.49II 5 (15.15%) 12 (36.36%) 10 (30.33%) 2 (6.06%) 4 (12.12%) 0 (0%)\nIII/IV 4 (13.33%) 11 (36.67%) 4 (13.33%) 4 (13.33%) 6 (20.00%) 1 (3.33%)\nVI. Duration of disease <5 years 14 (21.21%) 22 (33.33%) 15 (22.73%) 4 (6.06%) 9 (13.64%) 2 (3.03%) 2.33 0.80≥5 years 5 (14.71%) 11 (32.35%) 6 (17.65%) 4 (11.76%) 7 (20.59%) 1 (2.94%)\n5\n\nTable 8. Correlations between “Impact of disease-related costs on daily financial problems” and study variables.\nImpact of disease-related costs on daily financial problems χ² p-value\n“Not at all” “A little” “Moderately” “To a great extent” “To a very great extent”\nI. Age <30 years 14 (28%) 15 (30%) 14 (28%) 6 (12%) 1 (2%) 4.86 0.30≥30 years 10 (20%) 19 (38%) 8 (16%) 10 (20%) 3 (6%)\nII. Education levels Higher 15 (23.44%) 22 (34.38%) 16 (25.00%) 10 (15.63%) 1 (1.56%) 3.33 0.50Other 9 (25.00%) 12 (33.33%) 6 (16.67%) 6 (16.67%) 3 (8.33%)\nIII. Place of residence <10,000 6 (13.95%) 15 (34.88%) 10 (23.26%) 10 (23.26%) 2 (4.65%) 5.98 0.20≥10,000 18 (31.58%) 19 (33.33%) 12 (21.05%) 6 (10.53%) 2 (3.51%)\nIV . Parenthood (n = 98) Y es 11 (32.35%) 11 (32.35%) 7 (20.59%) 3 (8.82%) 2 (5.88%) 3.73 0.44No 13 (20.31%) 21 (32.81%) 15 (23.44%) 13 (20.31%) 2 (3.13%)\nV . Current stage of\nendometriosis\nI 14 (37.84%) 8 (21.62%) 10 (27.03%) 4 (10.81%) 1 (2.70%)\n16.87 0.03II 4 (12.12%) 17 (51.52%) 5 (15.15%) 7 (21.21%) 0 (0%)\nIII/IV 6 (20.00%) 9 (30.00%) 7 (23.33%) 5 (16.67%) 3 (10.00%)\nVI. Duration of disease <5 years 18 (27.27%) 22 (33.33%) 16 (24.24%) 7 (10.61%) 3 (4.55%) 4.86 0.30≥5 years 6 (17.65%) 12 (35.29%) 6 (17.65%) 9 (26.47%) 1 (2.94%)\nTable 9. Correlations between “Influence of endometriosis on realization of plans, dreams, and life goals” and study variables.\nInfluence of endometriosis on realization of plans, dreams, and life goals χ² p-value\n“Not at all” “A little” “Moderately” “V ery Much” “Fully”\nI. Age <30 years 7 (14%) 19 (38%) 6 (12%) 16 (32%) 2 (4%) 3.59 0.46≥30 years 8 (16%) 12 (24%) 9 (18%) 16 (32%) 5 (10%)\nII. Education levels Higher 9 (14.06%) 22 (34.38%) 9 (14.06%) 20 (31.25%) 4 (6.25%) 1.05 0.90Other 6 (16.67%) 9 (25.00%) 6 (16.67%) 12 (33.33%) 3 (8.33%)\nIII. Place of residence <10,000 5 (11.63%) 18 (41.86%) 3 (6.98%) 14 (32.56%) 3 (6.98%) 6.97 0.14≥10,000 10 (17.54%) 13 (22.81%) 12 (21.05%) 18 (31.58%) 4 (7.02%)\nIV . Parenthood (n = 98) Y es 10 (29.41%) 7 (20.59%) 7 (20.59%) 8 (23.53%) 2 (5.88%) 11.12 0.03No 5 (7.81%) 24 (37.50%) 7 (10.94%) 23 (35.94%) 5 (7.81%)\nV . Current stage of endometriosis\nI 6 (16.22%) 11 (29.73%) 7 (18.92%) 10 (27.03%) 3 (8.11%)\n3.94 0.86II 3 (9.09%) 13 (39.39%) 4 (12.12%) 11 (33.33%) 2 (6.06%)\nIII/IV 6 (20.00%) 7 (23.33%) 4 (13.33%) 11 (36.67%) 2 (6.67%)\nVI. Duration of disease <5 years 10 (15.15%) 23 (34.85%) 9 (13.64%) 20 (30.30%) 4 (6.06%) 1.62 0.81≥5 years 5 (14.71%) 8 (23.53%) 6 (17.65%) 12 (35.29%) 3 (8.82%)\nment. According to 19% of the respondents, endometrio-\nsis had no impact on employment (“not applicable”), 33%\nindicated “not at all”, while 21% answered “a little”, 8%\nanswered “moderately”, 16% answered “very much”, and\n3% of the women said the disease hinders their ability to\nwork “fully”. Participants from smaller cities reported sig-\nnificantly higher difficulty in obtaining employment due to\nthe disease ( p = 0.04). The correlations between “Disease-\nrelated difficulties in obtaining a job” and the study vari-\nables are presented in Table 7.\n3.3.6 Have Disease-Related Costs Caused Financial\nProblems in Y our Daily Life?\nThe participants were asked about the impact of\ndisease-related costs on their financial situation. According\nto 24% of the women, the costs disease-associated did not\naffect their financial situation (answered “not at all”), while\n34% answered “a little”, 22% answered “moderately”, 16%\nanswered “to a great extent”, and 4% answered “to a very\ngreat extent”. The study found that a higher disease severity\n(p = 0.03) was associated with a higher rating of the impact\nof disease-related costs on financial problems in daily life.\nThe correlations between the “Influence of disease-related\ncosts on financial problems in daily life” and the study vari-\nables are presented in Table 8.\n3.3.7 Do Y ou Believe That Endometriosis has Hinderes\nthe Achievement of Y our Plans, Dreams, and Life Goals?\nThe impact of endometriosis on preventing the realiza-\ntion of plans, dreams, and goals was examined in this group\nof women: 31% responded “a little”, 15% responded “mod-\nerately”, 32% responded “very much”, and 7% responded\n“fully”. Additionally, 15% stated that the disease did not\nprevent them from achieving their goals (answered “not at\n6\n\n\nTable 10. Correlations between “Satisfaction with sleep quality” and study variables.\nSatisfaction with sleep quality χ² p-value\n“V ery dissatisfied” “Dissatisfied” “Neither satisfied\nnor dissatisfied” “Satisfied” “Delighted”\nI. Age <30 years 3 (6%) 15 (30%) 17 (34%) 15 (30%) 0 (0%) 8.93 0.06≥30 years 6 (12%) 25 (50%) 10 (20%) 8 (16%) 1 (2%)\nII. Education levels Higher 5 (7.81%) 23 (35.94%) 17 (26.56%) 18 (28.13%) 1 (1.56%) 4.09 0.39Other 4 (11.11%) 17 (47.22%) 10 (27.78%) 5 (13.89%) 0 (0%)\nIII. Place of residence <10,000 3 (6.98%) 20 (46.51%) 10 (23.26%) 10 (23.26%) 0 (0%) 2.67 0.61≥10,000 6 (10.53%) 20 (35.09%) 17 (29.82%) 13 (22.81%) 1 (1.75%)\nIV . Parenthood (n = 98) Y es 7 (20.59%) 13 (38.24%) 7 (20.59%) 6 (17.65%) 1 (2.94%) 10.65 0.03No 2 (3.13%) 26 (40.63%) 19 (29.69%) 17 (26.56%) 0 (0%)\nV . Current stage of endometriosis\nI 2 (5.41%) 12 (32.43%) 13 (35.14%) 9 (24.32%) 1 (2.70%)\n5.78 0.67II 3 (9.09%) 14 (42.42%) 8 (24.24%) 8 (24.24%) 0 (0%)\nIII/IV 4 (13.33%) 14 (46.67%) 6 (20.00%) 6 (20.00%) 0 (0%)\nVI. Duration of disease <5 years 4 (6.06%) 21 (31.82%) 20 (30.30%) 20 (30.30%) 1 (1.52%) 11.78 0.02≥5 years 5 (14.71%) 19 (55.88%) 7 (20.59%) 3 (8.82%) 0 (0%)\nTable 11. Correlations between “Satisfaction with sexual life” and study variables.\nSatisfaction with sexual life χ² p-value\n“Not\napplicable”\n“V ery\ndissatisfied” “Dissatisfied” “Neither satisfied\nnor dissatisfied” “Satisfied” “Delighted”\nI. Age <30 years 4 (8%) 2 (4%) 10 (20%) 16 (32%) 14 (28%) 4 (8%) 5.29 0.38≥30 years 2 (4%) 6 (12%) 16 (32%) 13 (26%) 10 (20%) 3 (6%)\nII. Education levels Higher 1 (1.56%) 5 (7.81%) 14 (21.88%) 21 (32.81%) 17 (26.56%) 6 (9.38%) 9.92 0.08Other 5 (13.89%) 3 (8.33%) 12 (33.33%) 8 (22.22%) 7 (19.44%) 1 (2.78%)\nIII. Place of residence <10,000 2 (4.65%) 3 (6.98%) 12 (27.91%) 13 (30.23%) 11 (25.58%) 2 (4.65%) 1.18 0.95≥10,000 4 (7.02%) 5 (8.77%) 14 (24.56%) 16 (28.07%) 13 (22.81%) 5 (8.77%)\nIV . Parenthood (n = 98) Y es 2 (5.88%) 6 (17.65%) 6 (17.65%) 9 (26.47%) 7 (20.59%) 4 (11.76%) 8.63 0.12No 4 (6.25%) 2 (3.13%) 19 (29.69%) 19 (29.69%) 17 (26.56%) 3 (4.69%)\nV . Current stage of\nendometriosis\nI 4 (10.81%) 1 (2.70%) 7 (18.92%) 13 (35.14%) 8 (21.62%) 4 (10.81%)\n11.54 0.32II 1 (3.03%) 4 (12.12%) 10 (30.30%) 6 (18.18%) 11 (33.33%) 1 (3.03%)\nIII/IV 1 (3.33%) 3 (10.00%) 9 (30.00%) 10 (33.33%) 5 (16.67%) 2 (6.67%)\nVI. Duration of disease <5 years 5 (7.58%) 2 (3.03%) 16 (24.24%) 21 (31.82%) 17 (25.76%) 5 (7.58%) 7.64 0.18≥5 years 1 (2.94%) 6 (17.65%) 10 (29.41%) 8 (23.53%) 7 (20.59%) 2 (5.88%)\nall”). The respondents without children ( p = 0.03) were\nsignificantly more likely to report a higher impact of en-\ndometriosis on preventing the realization of life goals. The\ncorrelations between the “Influence of endometriosis on re-\nalization of plans, dreams, and life goals” and the study\nvariables are presented in Table 9.\n3.3.8 Are Y ou Satisfied With Y our Sleep Quality?\nThe majority of the study participants with en-\ndometriosis reported being “dissatisfied” with their sleep\nquality (40%), 27% were “neither satisfied nor dissatis-\nfied”, 23% reported being “satisfied”, 9% admitted to be-\ning “very dissatisfied”, and 1% were “delighted” with their\nsleep quality. Women without children (p = 0.03) and those\nwho had suffered from endometriosis for more than 5 years\n(p = 0.02) had significantly higher sleep quality satisfaction\nscores. The correlations between “Satisfaction with sleep\nquality” and the study variables are presented in Table 10.\n3.3.9 Are Y ou Satisfied With the Quality of Y our Sexual\nLife?\nThe impact of endometriosis on the quality of sexual\nlife was also analyzed. The majority of patients were nei-\nther satisfied nor dissatisfied (29%). The second-largest\ngroup comprised patients who were dissatisfied with the\nquality of their sexual lives (26%), while 24% reported be-\ning satisfied, 6% were not sexually active, and 8% were\n“very dissatisfied”. No statistically significant correlations\n7\n\nTable 12. Correlations between “Painkiller use” and study variables.\nPainkiller use χ² p-value\n“Do not use” “V ery rarely” “Rarely” “Often” “V ery often”\nI. Age <30 years 1 (2%) 3 (6%) 10 (20%) 21 (42%) 15 (30%) 7.24 0.12≥30 years 7 (14%) 1 (2%) 10 (20%) 15 (30%) 17 (34%)\nII. Education levels Higher 7 (10.94%) 3 (4.69%) 13 (20.31%) 24 (37.50%) 17 (26.56%) 4.19 0.38Other 1 (2.78%) 1 (2.78%) 7 (19.44%) 12 (33.33%) 15 (41.67%)\nIII. Place of residence <10,000 1 (2.33%) 3 (6.98%) 8 (18.60%) 15 (34.88%) 16 (37.21%) 5.95 0.21≥10,000 7 (12.28%) 1 (1.75%) 12 (21.05%) 21 (36.84%) 16 (28.07%)\nIV . Parenthood (n = 98) Y es 7 (20.59%) 1 (2.94%) 9 (26.47%) 8 (23.53%) 9 (26.47%) 13.49 0.01No 1 (1.56%) 3 (4.69%) 11 (17.19%) 27 (42.19%) 22 (34.38%)\nV . Current stage of endometriosis\nI 4 (10.81%) 2 (5.41%) 9 (24.32%) 14 (37.84%) 8 (21.62%)\n5.42 0.71II 1 (3.03%) 1 (3.03%) 5 (15.15%) 13 (39.39%) 13 (39.39%)\nIII/IV 3 (10.00%) 1 (3.33%) 6 (20.00%) 9 (30.00%) 11 (36.67%)\nVI. Duration of disease <5 years 3 (4.55%) 2 (3.03%) 14 (21.21%) 25 (37.88%) 22 (33.33%) 3.58 0.47≥5 years 5 (14.71%) 2 (5.88%) 6 (17.65%) 11 (32.35%) 10 (29.41%)\nTable 13. Correlations between “Feeling sad and depressed” and study variables.\nFeeling sad and depressed χ² p-value\n“Never” “Rarely” “Occasionally” “Frequently” “Always”\nI. Age <30 years 1 (2%) 15 (30%) 13 (26%) 18 (36%) 3 (6%) 5.21 0.27≥30 years 3 (6%) 7 (14%) 12 (24%) 25 (50%) 3 (6%)\nII. Education levels Higher 2 (3.13%) 14 (21.88%) 20 (31.25%) 24 (37.50%) 4 (6.25%) 4.61 0.33Other 2 (5.56%) 8 (22.22%) 5 (13.89%) 19 (52.78%) 2 (5.56%)\nIII. Place of residence <10,000 0 (0%) 11 (25.58%) 11 (25.58%) 19 (44.19%) 2 (4.65%) 5.20 0.27≥10,000 4 (7.02%) 11 (19.30%) 14 (24.56%) 24 (42.11%) 4 (7.02%)\nIV . Parenthood (n = 98) Y es 3 (8.82%) 5 (14.71%) 6 (17.65%) 18 (52.94%) 2 (5.88%) 6.45 0.17No 1 (1.56%) 17 (26.56%) 18 (28.13%) 24 (37.50%) 4 (6.25%)\nV . Current stage of endometriosis\nI 3 (8.11%) 7 (18.92%) 8 (21.62%) 16 (43.24%) 3 (8.11%)\n5.92 0.66II 0 (0%) 9 (27.27%) 8 (24.24%) 15 (45.45%) 1 (3.03%)\nIII/IV 1 (3.33%) 6 (20.00%) 9 (30.00%) 12 (40.00%) 2 (6.67%)\nVI. Duration of disease <5 years 2 (3.03%) 16 (24.24%) 18 (27.27%) 26 (39.39%) 4 (6.06%) 1.88 0.76≥5 years 2 (5.88%) 6 (17.65%) 7 (20.59%) 17 (50.00%) 2 (5.88%)\nwere observed between sexual life satisfaction and the study\nvariables (Table 11).\n3.3.10 How Frequently do Y ou Take Painkillers to Manage\nSymptoms Associated With Endometriosis?\nThe majority of women in this study (92%) reported\nusing painkillers. The options “very rarely”, “rarely”, “of-\nten”, and “very often” were selected by 4%, 20%, 36%,\nand 32% of the respondents, respectively. The remain-\ning 8% of the respondents did not use painkillers. The\nwomen without children exhibited a significantly higher ( p\n= 0.01) frequency of painkiller use. The correlations be-\ntween painkiller use and the study variables are presented\nin Table 12.\n3.4 Effect of Endometriosis on Emotions\n3.4.1 How Often do Y ou Feel Sad or Depressed?\nWhen asked whether they ever feel sad or de-\npressed, 4% of women responded “never”, 22% responded\n“rarely”, 25% responded “occasionally”, 43% answered\n“frequently”, and 6% responded “always”. No significant\ncorrelations were found between the frequency of sadness\nand depression and age, education, place of residence, par-\nenthood, disease stage, or disease duration (Table 13).\n3.4.2 How Often do Y ou Feel Joy or Happiness?\nA minor proportion of the participants (1%) reported\nthat they “never” experience joy and happiness, while the\nremaining 99% experienced positive emotions with varying\nfrequency: 28% responded “rarely”, 34% answered “oc-\n8\n\n\nTable 14. Correlations between “Experience of joy and happiness” and study variables.\nExperience of joy and happiness χ² p-value\n“Never” “Rarely” “Occasionally” “Frequently” “Always”\nI. Age <30 years 0 (0%) 10 (20%) 21 (42%) 19 (38%) 0 (0%) 7.10 0.13≥30 years 1 (2%) 18 (36%) 13 (26%) 17 (34%) 1 (2%)\nII. Education levels Higher 1 (1.56%) 16 (25.00%) 22 (34.38%) 24 (37.50%) 1 (1.56%) 2.46 0.65Other 0 (0%) 12 (33.33%) 12 (33.33%) 12 (33.33%) 0 (0%)\nIII. Place of residence <10,000 1 (2.33%) 14 (32.56%) 14 (32.56%) 14 (32.56%) 0 (0%) 3.66 0.45≥10,000 0 (0%) 14 (24.56%) 20 (35.09%) 22 (38.60%) 1 (1.75%)\nIV . Parenthood (n = 98) Y es 0 (0%) 12 (35.29%) 11 (32.35%) 10 (29.41%) 1 (2.94%) 4.39 0.36No 1 (1.56%) 16 (25.00%) 22 (34.38%) 25 (39.06%) 0 (0%)\nV . Current stage of endometriosis\nI 0 (0%) 7 (18.92%) 14 (37.84%) 15 (40.54%) 1 (2.70%)\n9.01 0.34II 0 (0%) 13 (39.39%) 8 (24.24%) 12 (36.36%) 0 (0%)\nIII/IV 1 (3.33%) 8 (26.67%) 12 (40.00%) 9 (30.00%) 0 (0%)\nVI. Duration of disease <5 years 0 (0%) 16 (24.24%) 22 (33.33%) 28 (42.42%) 0 (0%) 7.68 0.10≥5 years 1 (2.94%) 12 (35.29%) 12 (35.29%) 8 (23.53%) 1 (2.94%)\nTable 15. Quality of life responses based on participant characteristics.\nV ery bad Bad Neither good nor bad Good V ery good χ² p-value\nI. Age <30 years 0 (0%) 5 (10%) 24 (48%) 20 (40%) 1 (2%) 7.84 0.10≥30 years 2 (4%) 11 (22%) 16 (32%) 18 (36%) 3 (6%)\nII. Education levels Higher 1 (1.56%) 8 (12.50%) 24 (37.50%) 27 (42.19%) 4 (6.25%) 6.16 0.19Other 1 (2.78%) 8 (22.22%) 16 (44.44%) 11 (30.56%) 0 (0%)\nIII. Place of residence <10,000 1 (2.33%) 9 (20.93%) 17 (39.53%) 16 (37.21%) 0 (0%) 5.68 0.22≥10,000 1 (1.75%) 7 (12.28%) 23 (40.35%) 22 (38.60%) 4 (7.02%)\nIV . Parenthood (n = 98) Y es 1 (2.94%) 5 (14.71%) 11 (32.35%) 13 (38.24%) 4 (11.76%) 9.50 0.049No 1 (1.56%) 11 (17.19%) 28 (43.75%) 24 (37.50%) 0 (0%)\nV . Current stage of endometriosis\nI 1 (2.70%) 4 (10.81%) 15 (40.54%) 15 (40.54%) 2 (5.41%)\n5.99 0.65II 1 (3.03%) 6 (18.18%) 14 (42.42%) 12 (36.36%) 0 (0%)\nIII/IV 0 (0%) 6 (20.00%) 11 (36.67%) 11 (36.67%) 2 (6.67%)\nVI. Duration of disease <5 years 1 (1.52%) 7 (10.61%) 30 (45.45%) 25 (37.88%) 3 (4.55%) 5.19 0.27≥5 years 1 (2.94%) 9 (26.47%) 10 (29.41%) 13 (38.24%) 1 (2.94%)\ncasionally”, 36% answered “frequently”, and 1% of the\nwomen were “always”. No significant correlations were\nobserved between the frequency of feeling joy and happi-\nness and the study variables (Table 14).\n3.5 Quality of Life\nHow Would Y ou Rate Y our Quality of Life?\nMost of the respondents rated their quality of life\n(42%) positively, with 38% considering their quality of life\nto be “good” and 4% considering it to be “very good”. How-\never, 40% of respondents answered “neither good nor bad”.\nOnly 16% of the respondents answered that their quality of\nlife was “bad”, while 2% answered “very bad”. An analysis\nof the data showed that those without children were signif-\nicantly more likely to rate their quality of life as “neither\ngood nor bad” ( p = 0.049). The quality-of-life responses\nbased on the different participant characteristics are pre-\nsented in Table 15.\n3.6 Additional Analysis\nCombining response categories—for exam-\nple, collapsing a five-point scale into two categories\n(“yes”/“no”)—can unify frequencies within table cells\nand improve statistical control. However, such category\ncombination is not always methodologically appropriate, as\nit can obscure information about response gradation (e.g.,\ndifferences between “rather yes” and “definitely yes”)\nand oversimplify the interpretation of phenomena. Any\nsuch modification is justified only when it is significantly\nmeaningful. Fisher’s exact test was used only for 2 × 2\ntables because it is the statistically appropriate and most\nfrequently used method for such analysis.\nConverting the scale from nominal to ordinal–by as-\nsigning numerical values (e.g., 1–5) to response categories–\nenable the use of nonparametric tests, such as Mann–\nWhitney U (for two groups) or the Kruskal–Wallis (for three\n9\n\nor more groups). This approach allows comparison of me-\ndians and response distributions between groups instead of\nrelying solely on frequencies. This approach can serve as\na complementary analysis; if the results of nonparamet-\nric tests are consistent with those of the Chi-square tests,\nthe reliability and interpretability of the conclusions are in-\ncreased, despite the limitations imposed by the small sam-\nple size.\nThe tables present a classification of the results, dis-\ntinguishing analyses with statistically significant findings\nand large or medium effect sizes, which can be considered\nimportant findings (Table 16), from those requiring further\ntesting or modification (Table 17).\n4. Discussion\nChronic pain (with typical cyclicity and severity) and\ninfertility resulting from endometriosis, alone or in com-\nbination, can significantly reduce the quality of life of af-\nfected women due to significant social and psychological\nimpacts on daily activities, intimate relationships, family\nplanning, education, work, mental health, and emotional\nwell-being [ 12,13,16–25]. Sexual functioning is a critical\naspect of overall functioning, closely linked to other do-\nmains and affected by disease symptoms [ 26]. Dyspare-\nunia occurs four times more frequently in women with en-\ndometriosis and five times more frequently in those with\nperitoneal endometriosis than in controls [ 27]. Previous\nstudies have reported decreased satisfaction with sexual\nlife and its negative impact on relationships with partners\n[21,26,28]. Baczek et al . [ 29] observed that women with\na history of endometriosis lasting more than 3 years re-\nported dyspareunia, bladder pain, and lower back pain sig-\nnificantly more often. In addition, the severity of dys-\nmenorrhea seems to be associated with a lower quality of\nlife. However, chronic pelvic pain and dyspareunia in en-\ndometriosis may not negatively impact the quality of life of\nfertile Turkish women, even in the most advanced stages\nof the disease [ 30]. Worse sexual quality of life in women\nwith endometriosis was significantly and independently as-\nsociated with the presence of dyspareunia, more severe dys-\nmenorrhea, and unemployment [ 31]. In the current study,\nno correlations were found between the quality of sexual\nlife and the severity or duration of the disease. According\nto Łuczak-Wawrzyniak et al. [ 32], endometriosis does not\nnecessarily lead to a deterioration of quality of life, as it\nmay result in the redistribution of personal resources that\nhelp patients achieve goals and fulfill important life needs.\nWomen adapt to the course of the disease, enabling them to\nmaintain good relationships, plans for the future, and expe-\nrience life satisfaction [ 32].\nWilk [33] suggests that prolonged pain can negatively\naffect the psychological well-being. According to Wilk\n[33], there is a strong association between patients’ pain\ncomplaints and the onset of depressive or anxiety disorders.\nIn the present study, more than 90% of the respondents re-\nported using painkillers. Regarding emotions, most respon-\ndents reported experiencing sadness and depression more\nfrequently than joy and happiness. Women without children\nwere significantly more likely to report heightened feelings\nof societal rejection. Matasariu et al . [ 34] also showed a\nsignificant presence of high infertility-related stress across\nall age groups, contributing to depression and social anxi-\nety.\nRuszała et al. [ 35] noted that fatigue becomes increas-\ningly prevalent in women’s daily lives as the disease pro-\ngresses. Patients with endometriosis also exhibit poor sleep\nquality [ 36], which is associated with dysmenorrhea, dys-\npareunia, pelvic pain, low levels of physical activity, and\nreduced intake of dairy products, fruits, and nuts [ 37]. The\ncurrent study found that nearly half of the participants were\ndissatisfied with their sleep quality. However, women who\nhad suffered from endometriosis for more than 5 years re-\nported significantly higher sleep satisfaction scores. Ac-\ncording to Łuczak-Wawrzyniak et al. [ 32], this can be at-\ntributed to adapting to and accepting the disease.\nFor most individuals, having children is highly impor-\ntant; thus, infertility represents a major life challenge [ 38].\nA significant concern for female patients with endometrio-\nsis is the inability to conceive or carry a pregnancy, prevent-\ning them from fulfilling their desire to have children. Pre-\nvious studies have demonstrated that endometriosis-related\ninfertility adversely impacts quality of life and exacerbates\nanxiety and depression [ 39–43].\nBień et al. [ 43] observed that the main clinical factors\ninfluencing the quality of life in women with endometriosis\nare difficulties conceiving and sexual problems. This study\ndemonstrated that women without children reported signif-\nicantly stronger feelings of societal lack of acceptance due\nto infertility (p = 0.03) and were significantly more likely to\nreport a higher impact of endometriosis on preventing the\nrealization of life goals (p = 0.03). Moreover, they were sig-\nnificantly more likely to rate their quality of life as “neither\ngood nor bad” (p = 0.049). All the participants in this study\nwere more likely to feel sad and depressed than happy, and\nnearly half were dissatisfied with their sleep quality. How-\never, it appears that a lack of children may have a significant\nimpact on the quality of life of women with endometrio-\nsis. This suggests the need for care and emotional support\nin infertility management, especially when associated with\nendometriosis [ 44]. In this study, we used a newly devel-\noped questionnaire written in clear, colloquial language ac-\ncessible to all patients. It was administered electronically\nand distributed through social networks and support groups\nfor women with endometriosis, which may have introduced\nselection bias. The population may overrepresent patients\nwho are more symptomatic or actively engaged. V alidated\ntools are commonly used in research to assess quality of life\n[16–20]. However, Dowrick et al. [ 45] have shown that the\ncontext and characteristics of the studied population may\ninfluence the measurements obtained using validated que-\n10\n\n\nTable 16. Important discovery.\nIndependent variable Dependent variable Degrees of freedom χ² p Fisher test Phi coefficient/Cramér’s V\np φ/V\nAge “Problems conceiving due to endometriosis” 2 × 3 and more 25.92 <0.001 - 0.49\n“Influence of health condition on daily activities” 2 × 3 and more 10.17 0.038 - 0.31\nEducation\npain during bowel movements 2 × 2 (df = 1) 9.09 0.003 0.003 0.30\n“Influence of health condition on daily activities” 2 × 3 and more 14.69 0.005 - 0.36\n“Influence of health status on physical activity” 2 × 3 and more 16.18 0.003 - 0.40\nPlace of residence “Disease-related difficulty to get a job” 2 × 3 and more 11.68 0.039 - 0.32\nChildren\npain during menstruation 2 × 2 (df = 1) 11.33 0.001 0.001 0.35\n“Problems conceiving due to endometriosis” 2 × 3 and more 44.00 <0.001 - 0.65\n“Perceived societal lack of acceptance due infertility” 2 × 3 and more 12.11 0.017 - 0.33\n“Painkillers” 2 × 3 and more 13.49 0.009 - 0.37\n“Satisfaction with sleep quality” 2 × 3 and more 10.65 0.031 - 0.33\n“Influence of endometriosis on realization of plans, dreams, and life goals” 2 × 3 and more 11.12 0.025 - 0.34\nQuality of life 2 × 3 and more 9.50 0.049 - 0.30\nCurrent stage\nPain during bowel movements 2 × 3 and more 9.60 0.008 - 0.30\n“Problems conceiving due to endometriosis” 2 × 3 and more 11.04 0.026 - 0.24\n“Influence of disease-related costs on financial problems in daily life” 2 × 3 and more 16.87 0.031 - 0.29\nDuration of disease “Problems conceiving due to endometriosis” 2 × 3 and more 13.47 0.001 - 0.35\n“Satisfaction with sleep quality” 2 × 3 and more 11.78 0.019 - 0.33\n11\n\nTable 17. Need more testing/modification.\nIndependent variable Dependent variable Degrees of freedom χ² p Fisher test Phi coefficient/Cramér’s V\np φ/V\nAge\n“Influence of health status on physical activity” 2 × 3 and more 8.74 0.07 - 0.29\n“Influence of disease-related costs on financial problems in daily life” 2 × 3 and more 4.86 0.30 - 0.22\n“Painkillers” 2 × 3 and more 7.24 0.12 - 0.26\n“Satisfaction with sexual life” 2 × 3 and more 5.29 0.38 - 0.23\n“Satisfaction with sleep quality” 2 × 3 and more 8.93 0.06 - 0.29\n“Experiencing sadness and depression” 2 × 3 and more 5.21 0.27 - 0.23\n“Experiencing joy and happiness” 2 × 3 and more 7.10 0.13 - 0.25\nQuality of life 2 × 3 and more 7.84 0.10 - 0.26\nEducation\n“Disease-related difficulty to get a job” 2 × 3 and more 10.44 0.06 - 0.31\n“Satisfaction with sexual life” 2 × 3 and more 9.92 0.08 - 0.31\nQuality of life 2 × 3 and more 6.16 0.19 - 0.22\nPlace of residence\n“Problems conceiving due to endometriosis” 2 × 3 and more 4.50 0.11 - 0.21\n“Influence of health status on physical activity” 2 × 3 and more 5.21 0.27 - 0.21\n“Influence of disease-related costs on financial problems in daily life” 2 × 3 and more 5.98 0.20 - 0.24\n“Painkillers” 2 × 3 and more 5.95 0.20 - 0.23\n“Influence of endometriosis on realization of plans, dreams, and life goals” 2 × 3 and more 6.97 0.14 - 0.26\nChildren\n“Disease-related difficulty to get a job” 2 × 3 and more 10.75 0.06 - 0.32\n“Satisfaction with sexual life” 2 × 3 and more 8.63 0.12 - 0.30\n“ Experiencing sadness and depression” 2 × 3 and more 6.45 0.17 - 0.26\nCurrent stage\nPain during intercourse 2 × 3 and more 5.56 0.06 - 0.23\n“Influence of health status on physical activity” 2 × 3 and more 10.08 0.26 - 0.21\n“Satisfaction with sexual life” 2 × 3 and more 11.54 0.32 - 0.23\nDuration of disease\n“Influence of health status on physical activity” 2 × 3 and more 6.59 0.16 - 0.26\n“Influence of disease-related costs on financial problems in daily life” 2 × 3 and more 4.86 0.30 - 0.22\n“Satisfaction with sexual life” 2 × 3 and more 7.64 0.18 - 0.28\n“Experiencing joy and happiness” 2 × 3 and more 7.68 0.10 - 0.27\nQuality of life 2 × 3 and more 5.19 0.27 - 0.23\n12\n\n\nstionaries. In particular, when the tools have not been val-\nidated in the population of interest, it may lead to mea-\nsurement errors and uncertain conclusions. Becker et al .\n[2] noted the heterogeneity of endometriosis symptoms be-\ntween populations from six different European countries.\nPoland had the highest proportion of women experiencing\nat least one of the three typical symptoms of endometriosis\n(pelvic pain, pain during or after intercourse, or dysmen-\norrhea [91%]), while Hungary had the lowest percentage\n(68.8%). In addition, Polish patients reported severe pain\nmore frequently. Alternatively, global assessment mea-\nsures based on direct self-reporting [ 46,47] or online sur-\nveys [ 48] can be used. While validated instruments offer\ngreater objectivity, they are often time-consuming. Non-\nvalidated instruments such as global assessments are easier\nto administer but may be more subjective [ 49].\nTo date, studies examining the impact of endometrio-\nsis on quality of life have focused on different aspects\nof patient well-being. In Polish populations, the find-\nings are sometimes contradictory. For example, Łuczak-\nWawrzyniak et al. [ 32] concluded that endometriosis does\nnot necessarily lead to a deterioration in women’s quality of\nlife, whereas Bień et al. [ 43] showed that difficulties con-\nceiving and sexual problems adversely affect the quality of\nlife of affected women. Surgical treatment plays an impor-\ntant role in managing endometriosis, particularly in severe\nor treatment-resistant cases. While laparoscopic excision\ncan relieve pain and improve fertility, it may also lead to\ncomplications [ 50–52]. Sexual health in women with en-\ndometriosis is multifactorial, influenced not only by the dis-\nease itself but also by coexisting conditions such as pelvic\nfloor hypertonicity and chronic pelvic pain [ 53,54]. These\noverlapping factors contribute to dyspareunia and broader\nsexual dysfunction, underscoring the need for a multidisci-\nplinary, biopsychosocial approach to management.\nTherefore, the aim of this study was to assess the im-\npact of endometriosis on the quality of life of Polish women\nbased on determinants extracted from a comprehensive lit-\nerature search: age, education levels, place of residence,\nparenthood, current disease stage, and duration of disease.\nConsidering the high variability and severity of endometrio-\nsis symptoms across different populations, the use of a\nnewly created questionnaire could uncover previously hid-\nden factors influencing the quality of life of women with\nendometriosis in Poland.\nLimitations\nFactors such as comorbidities, treatment type, socioe-\nconomic status, or psychological support were not con-\ntrolled, which may influence perceived quality of life. The\nquestionnaire was administered electronically via Google\nForms and distributed through social networks and support\ngroups for women with endometriosis. Participation was\nvoluntary, anonymous, and conducted entirely online.\n5. Conclusions\nEndometriosis is a condition that affects multiple as-\npects of a woman’s life. Our findings indicate that its\nnegative impacts are complex and multidimensional, with\nmost participants reporting sadness and depression rather\nthan happiness, and nearly half expressing dissatisfaction\nwith their sleep quality. While validated instruments offer\ngreater objectivity, they are often time-consuming. Non-\nvalidated instruments, such as global assessments, are eas-\nier to administer but may be more subjective.\nAvailability of Data and Materials\nThe data presented in this study are available upon re-\nquest from the corresponding author.\nAuthor Contributions\nEM study conception, data collection and analy-\nsis, drafting of the manuscript; KC-W drafting of the\nmanuscript; study conception, design and supervision; KW\nstudy conception, design and supervision; MWierz and\nMW analysis and interpretation of data, revision of the\nmanuscript for important intellectual content. All authors\ncontributed to editorial changes in the manuscript. All au-\nthors read and approved the final manuscript. All authors\nhave participated sufficiently in the work and agreed to be\naccountable for all aspects of the work\nEthics Approval and Consent to Participate\nThe study participants were informed that participa-\ntion in the study was anonymous and voluntary, and that the\nresults obtained would only be used for scientific purposes.\nThe ethical review and approval were waived for this study\nby the Bioethics Committee of Poznan University of Med-\nical Sciences, due to the fact that it was not a medical ex-\nperiment and did not involve patients, and as such, approval\nwas not necessary according to Polish law (KB-282/25, date\n23.04.2025). The study was carried out in accordance with\nthe guidelines of the Declaration of Helsinki.\nAcknowledgment\nNot applicable.\nFunding\nThis research received no external funding.\nConflict of Interest\nThe authors declare no conflict of interest. Katarzyna\nWszołek and Karolina Chmaj-Wierzchowska are serving as\nthe Guest editors of this journal. We declare that Katarzyna\nWszołek and Karolina Chmaj-Wierzchowska had no in-\nvolvement in the peer review of this article and has no ac-\ncess to information regarding its peer review. Full responsi-\nbility for the editorial process for this article was delegated\nto Michael H. Dahan.\n13\n\nReferences\n[1] Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F,\nKiesel L, et al. ESHRE Endometriosis Guideline Group. ESHRE\nguideline: endometriosis. Hum Reproduction Open. 2022;\n2022: hoac009. https://doi.org/10.1093/hropen/hoac009.\n[2] Becker K, Heinemann K, Imthurn B, Marions L, Moehner S,\nGerlinger C, et al . Real world data on symptomology and di-\nagnostic approaches of 27,840 women living with endometrio-\nsis. Scientific Reports. 2021; 11: 20404. https://doi.org/10.1038/\ns41598-021-99681-3 .\n[3] International Working Group of AAGL, ESGE, ESHRE and\nWES, Tomassetti C, Johnson NP , Petrozza J, Abrao MS, Einars-\nson JI, et al . 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