Medical and psychosocial influences on quality of life in endometriosis: A holistic narrative review

Katharina Helgerth, Astrid Schütz
In: Journal of Endometriosis and Pelvic Pain Disorders · 2026 · doi:10.1177/22840265251411717 · W7125604399
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This review integrates medical and psychosocial factors affecting quality of life in endometriosis, finding that chronic pain, infertility, and psychological distress significantly impair well-being, necessitating a holistic care approach.

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This holistic narrative review synthesizes data from numerous cross-sectional, longitudinal, and qualitative studies to examine how medical and psychosocial factors influence quality of life in patients with endometriosis. The analysis highlights that pain intensity, psychological distress, coping strategies, and social support are significant determinants of health-related quality of life across diverse patient populations. While the review aggregates findings on treatment effects and emotional well-being, it relies heavily on observational data which limits causal inference regarding these complex interactions. This paper is centrally about endometriosis — specifically exploring the multifaceted impact of disease burden and psychosocial variables on patient-reported outcomes.

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Abstract

Endometriosis is a chronic gynecological condition with profound consequences. Despite increasing research, studies on health-related quality of life (HRQoL) in endometriosis remain fragmented, often neglecting the interplay between medical and psychosocial aspects. This narrative review aims to provide an integrated perspective on the medical and psychosocial factors influencing HRQoL in individuals with endometriosis. A comprehensive literature search identified peer-reviewed studies examining both qualitative and quantitative research. Medical aspects such as chronic pain, dysmenorrhea, infertility, dyspareunia, fatigue, and treatment side effects were strongly associated with reduced HRQoL. Psychosocial aspects included depression, anxiety, self-esteem, body-image, coping strategies, illness perceptions, and social and work-related challenges. Treatment-related aspects, including diagnostic delay and patient-centered care, emerged as important factors associated with HRQoL. The findings highlight the necessity of a holistic approach to improve patients’ HRQoL. However, research on the implementation and effectiveness of such approaches remains scarce. Future research should prioritize adolescents, longitudinal designs, and integrative analytic frameworks to better capture both short and long-term effects of the complex interactions between medical and psychosocial factors relevant to HRQoL in those affected.
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Abstract

Introduction

Methods

| Authors (year) | Study design | Sample | Main variables | Analytical methods | |---|---|---|---|---| | Ahmad et al. (2024) | Cross-sectional study | 354 endometriosis patients | Quality of life, pain intensity, patient health engagement | Correlation analysis, structural equation modeling | | Barberis et al. (2023) | Cross-sectional study | 364 endometriosis patients | Quality of life, emotional intelligence, illness perceptions, psychological distress | Structural equation modeling, mediator analysis | | Bień et al. (2020) | Cross-sectional study | 309 endometriosis patients | Quality of life, acceptance of illness, pain intensity | Regression analysis | | Bień et al. (2024) | Cross-sectional study | 425 endometriosis patients | Quality of life | Regression analysis | | de Barros Meneguetti et al. (2022) | Cross-sectional study | 102 endometriosis patients | Quality of life, anxiety, depression, pain intensity | Comparative analysis | | De Graaff et al. (2013) | Cross-sectional study | 931 endometriosis patients | Quality of life | Regression analysis | | Del Forno et al. (2024) | Cross-sectional study | 334 endometriosis patients | Quality of life, sexual function | Comparative analysis | | Facchin et al. (2015) | Cross-sectional study | 110 endometriosis patients, 61 healthy controls | Quality of life, anxiety, depression, pain intensity | Comparative analysis, regression analysis | | Gallagher et al. (2018) | Cross-sectional study | 360 endometriosis patients, 207 controls, 10–24 years | Quality of life | Comparative analysis, correlation analysis | | González-Echevarría et al. (2019) | Cross-sectional study | 24 endometriosis patients (13–25 years) | Quality of life, coping styles, anxiety, depression | Correlation analysis | | Grinberg et al. (2024) | Cross-sectional study | 89 endometriosis patients, 81 healthy controls | Quality of life, psychological well-being, catastrophizing | Comparative analysis, correlation analysis | | Güvenç and Bozo (2023) | Cross-sectional study | 174 endometriosis patients | Quality of life, attachment style, pain catastrophizing, coping strategies | Path analysis, mediation analysis | | Guillemot et al. (2024) | Cross-sectional study | 1039 endometriosis patients | Quality of life, pain severity, body-image, self-esteem, anxiety, depression | Regression analysis | | Jaeger et al. (2024) | Cross-sectional study | 627 endometriosis patients | Quality of life, relationship quality | Correlation analysis, mediation analysis | | Jones et al. (2004) | Qualitative study | 24 endometriosis patients | Quality of life | Text analysis, coding | | Kupec et al. (2025) | Cross-sectional study | 175 endometriosis patients | Quality of life, pain severity | Regression analysis | | Lövkvist et al. (2016) | Cross-sectional study | 431 endometriosis patients | Quality of life | Comparative analysis | | Márki et al. (2017) | Cross-sectional study | 193 endometriosis patients | Quality of life, perceived stress, anxiety, depression, emotional regulation | Correlation analysis, structural equation modeling, mediator analysis | | Matías-González et al. (2022) | Cross-sectional study | 169 endometriosis patients | Quality of life, social support, self-esteem | structural equation modeling | | McPeak et al. (2018) | Cross-sectional study | 236 endometriosis patients | Quality of life, pain catastrophizing | Regression analysis | | Melis et al. (2015) | Cross-sectional study | 41 endometriosis patients, 40 healthy controls | Quality of life, depression, anxiety, body image, pain intensity, sexual functioning | Correlation analysis, comparative analysis | | Moore et al. (2023) | Qualitative study | 30 endometriosis patients | Quality of life, illness perceptions | Reflexive thematic analysis | | Mundo-López et al. (2020) | Cross-sectional study | 230 endometriosis patients | Quality of life, fatigue, psychosocial status | Regression analysis | | Nielsen et al. (2023) | Qualitative study | 7 endometriosis patients | Quality of life | Structure analysis | | Nnoaham et al. (2011) | Cross-sectional study | 745 endometriosis patients, 673 controls | Diagnostic delay, HRQoL, work productivity | Comparative analysis, regression analysis | | Nogueira Neto et al. (2023) | Longitudinal study (3–6 months) | 102 endometriosis patients | Quality of life | Comparative analysis | | O’Hara et al. (2021) | Cross-sectional study | 620 endometriosis patients | Quality of life, self-management factors | Regression analysis | | Pehlivan et al. (2022) | Longitudinal study (2 months) | 996 participants at T0, 451 participants at T1 and T2 | Quality of life, body image, depression, self-esteem, rumination | Regression analysis, mediation analysis | | Pessoa de Farias Rodrigues et al. (2020) | Cross-sectional study | 106 endometriosis patients | Quality of life, endometriosis stage | Correlational analysis, comparative analysis | | Pontoppidan et al. (2023) | Cross-sectional study | 476 endometriosis patients | Quality of life | Regression analysis | | Rees et al. (2022) | Cross-sectional study | 230 endometriosis patients | Quality of life, pain self-efficacy, health locus of control, coping style, illness uncertainty | Regression analysis | | Ribeiro et al. (2014) | Longitudinal, prospective study (1 year) | 40 endometriosis patients | Quality of life | Comparative analysis | | Roomaney and Kagee (2018) | Qualitative study | 25 endometriosis patients | Quality of life | Coding | | Skinner and Kuijer (2024) | Cross-sectional study | 603 endometriosis patients | Quality of life, self-compassion, resilience | Correlation analysis, mediator analysis | | Soliman et al. (2017) | Cross-sectional study | 1269 endometriosis patients | Quality of life | Regression analysis | | Souza et al. (2011) | Cross-sectional study | 32 endometriosis patients, 25 controls | Quality of life, pain intensity | Comparative analysis, correlation analysis | | Spinoni et al. (2024) | Cross-sectional study | 273 endometriosis patients | Quality of life, pain severity, illness perceptions, coping strategies | Structural equation modeling, mediator analysis | | Sullivan-Myers et al. (2021) | Cross-sectional study | 584 endometriosis patients | Quality of life, psychological distress | Regression analysis | | Tiringer et al. (2022) | Retrospective and longitudinal study (6–10 weeks) | 115 endometriosis patients | Quality of life | Comparative analysis | | Valentin et al. (2017) | Prospective and longitudinal study (1 year) | 167 endometriosis patients | Quality of life | Comparative analysis | | Van Niekerk Steains, et al. (2022) | Cross-sectional study | 318 endometriosis patients, 420 controls | Quality of life, body image, depression, anxiety | Regression analysis, comparative analysis | | Van Niekerk, Johnstone, and Matthewson (2022) | Cross-sectional study | 318 endometriosis patients | Quality of life, pain, distress | Correlation analysis | | Van Niekerk et al. (2023) | Cross-sectional study | 318 endometriosis patients | Quality of life, self-compassion, body compassion | Correlation analysis, regression analysis | | Van Poll et al. (2020) | Cross-sectional study | 224 endometriosis patients | Quality of life, sexual function | Univariate analysis, regression analysis | | Wu et al. (2024) | Cross-sectional study | 216 endometriosis patients | Quality of life, self-management strategies, distress | Regression analysis |

Results

Medical factors Treatment-related aspects Mental-health aspects Aspects of coping Social life and work-related aspects

Discussion

Conclusion Declaration of conflicting interests Funding ORCID iDs Data availability statement

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Condition tags

endometriosisdysmenorrheadyspareuniainfertility

Citation neighborhood

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