Multidimensional factors increase menstrual distress in patients with endometriosis

BACKGROUND: Endometriosis is a chronic endocrine and inflammatory disease commonly presenting with dysmenorrhea, pelvic pain, and/or infertility. Despite the importance of menstrual symptoms, the impact of menstruation on stress is still poorly assessed. This study aims to objectively measure menstrual distress and identify its determinants in patients with endometriosis. MATERIALS AND METHODS: A cross-sectional study was conducted over one year, including 75 patients newly diagnosed with endometriosis and an age-matched control group (n = 75) of healthy women. All participants completed the Menstrual Distress Questionnaire (MEDI-Q), which explores 25 items and provides a total score along with subscales: Menstrual Symptoms (MS), Menstrual Symptoms Distress (MSD), and Menstrual Specificity Index (MESI). Scores were compared between cases and controls. A sub-analysis among endometriosis patients identified the key contributors to distress. RESULTS: Women with endometriosis showed significantly higher score for MEDI-Q Total (median = 14.00, interquartile range: [5.00---30.50] vs 12.00 [2.00---20.00], p < 0.05) as well for the subscale MSD (2.24 [1.67---2.81] vs 1.71 [1.00---2.30], p < 0.01) compared to controls. Menstrual distress was primarily associated with dyspareunia, dyschezia, dysuria, gastrointestinal symptoms (nausea, diarrhea, constipation, decreased appetite), reduced sexual drive, impaired concentration, and insomnia. A heightened perception of discomfort with bleeding, particularly in the presence of adenomyosis, further increased distress. CONCLUSION: Menstrual distress is significantly higher in women with endometriosis and involves multidimensional factors beyond pain. These findings support the need for a personalized and comprehensive approach in the clinical management of endometriosis.