A multi-centre study of the impact of endometriosis on health-related quality of life and work productivity

Kelechi Nnoaham
2011 · doi:10.5287/ora-g2yjvzke7 · W2122454177
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This multi-center study found that endometriosis significantly impairs health-related quality of life and work productivity, with a mean diagnostic delay of 9.2 years and substantial indirect costs due to lost work hours.

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This multi-centre, cross-continental study recruited 1,418 women aged 18–45 in 10 countries who had not previously received a surgical diagnosis of endometriosis; participants completed pre-operative questionnaires on symptoms, diagnostic delay, health-related quality of life (HRQoL), and work productivity, while surgeons provided standardized laparoscopy findings and endometriosis stage. The mean diagnostic delay was 9.2 years and was longer in centres with predominantly state-funded healthcare, and delay correlated with greater numbers of pelvic symptoms and higher body mass index. Compared with women who had similar symptoms but no endometriosis, affected women had significantly reduced physical HRQoL, and non-employment, severe pelvic pain, and moderate-severe disease were associated with further physical HRQoL reduction; women with endometriosis also lost about 10 hours of work per week with substantial indirect costs varying by country. This paper is centrally about endometriosis — it quantifies how endometriosis impacts HRQoL and work productivity across countries and relates these outcomes to diagnostic delay and disease presence/stage.

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Abstract

Background: Endometriosis is a common condition in women of reproductive age, causing pelvic pain and subfertility, but little is known about its impact on health-related quality of life (HRQoL) and work productivity worldwide.Methods: In 10 countries across five continents, this study recruited 1,418 women, aged 18-45, without a previous surgical diagnosis of endometriosis, scheduled to undergo a laparoscopy to investigate symptoms suggestive of endometriosis or to be sterilised. Pre-operatively, women completed a standardised questionnaire assessing symptoms, diagnostic delay, HRQoL and work productivity using validated instruments. Surgeons completed a standardised questionnaire incorporating findings at laparoscopy including endometriosis stage according to revised American Fertility Society criteria.Results: There was a mean delay of 9.2 years (SD 8.8), principally in primary care, between the onset of symptoms and diagnostic laparoscopy. This diagnostic delay was longer in centres where healthcare was predominantly state-funded (12.8 vs. 7.6 years; p<0.001). In multivariate analyses, the delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia and heavy periods; p<0.001) and a higher body mass index (p<0.001). Physical HRQoL was significantly reduced in affected women compared to those with similar symptoms and no endometriosis (p=0.012). Not being in paid employment, severe pelvic pain and moderate-severe disease were associated with reduced physical HRQoL (all p<0.001). Each affected woman lost on average 10.0 hours (SD 10.6) of work weekly, due mainly to reduced effectiveness while working. The annual indirect cost of endometriosis associated with work productivity loss ranged from US$399 per woman in Ibadan (Nigeria) to US$18,586 per woman in Boston (USA).Conclusions: Endometriosis significantly impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity.
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Background

Endometriosis is a common condition in women of reproductive age, causing pelvic pain and subfertility, but little is known about its impact on health-related quality of life (HRQoL) and work productivity worldwide.

Methods

In 10 countries across five continents, this study recruited 1,418 women, aged 18-45, without a previous surgical diagnosis of endometriosis, scheduled to undergo a laparoscopy to investigate symptoms suggestive of endometriosis or to be sterilised. Pre-operatively, women completed a standardised questionnaire assessing symptoms, diagnostic delay, HRQoL and work productivity using validated instruments. Surgeons completed a standardised questionnaire incorporating findings at laparoscopy including endometriosis stage according to revised American Fertility Society criteria.

Results

There was a mean delay of 9.2 years (SD 8.8), principally in primary care, between the onset of symptoms and diagnostic laparoscopy. This diagnostic delay was longer in centres where healthcare was predominantly state-funded (12.8 vs. 7.6 years; p<0.001). In multivariate analyses, the delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia and heavy periods; p<0.001) and a higher body mass index (p<0.001). Physical HRQoL was significantly reduced in affected women compared to those with similar symptoms and no endometriosis (p=0.012). Not being in paid employment, severe pelvic pain and moderate-severe disease were associated with reduced physical HRQoL (all p<0.001). Each affected woman lost on average 10.0 hours (SD 10.6) of work weekly, due mainly to reduced effectiveness while working. The annual indirect cost of endometriosis associated with work productivity loss ranged from US$399 per woman in Ibadan (Nigeria) to US$18,586 per woman in Boston (USA).

Conclusions

Endometriosis significantly impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity. Actions Access Document - Files: - - (bin, 5.8MB, Terms of use) - Authors Contributors - Publication date: - 2011 - DOI: - Type of award: - DPhil - Level of award: - Doctoral - Awarding institution: - Oxford University, UK - Language: - English - Keywords: - Subjects: - UUID: - uuid:b514d4e4-f001-4f73-ba57-72f69d742c64 - Local pid: - ora:5657 - Deposit date: - 2011-08-24 - ARK identifier: Terms of use - Copyright holder: - Nnoaham, K - Copyright date: - 2011 If you are the owner of this record, you can report an update to it here: Report update to this record

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endometriosischronic_pelvic_paindysmenorrheadyspareunia

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