Evaluating quality of life improvements in endometriosis patients following laparoscopic surgery using EHP-30 scale

Study design and participants This study was designed as a prospective observational study conducted at Fujian Maternity and Child Health Hospital. Seventy women with regular menstrual cycles who underwent laparoscopic procedures during the proliferative phase. These participants were treated at Fujian Maternity and Child Health Hospital between January and November 2020. A preliminary power analysis was conducted prior to participant recruitment to determine the required sample size. Based on expected effect sizes from similar studies, the power analysis indicated that 70 participants would provide 80% power to detect significant changes in HRQoL scores with a 95% confidence level. This sample size was chosen to balance statistical power with the available resources and time frame. Patients were not receiving hormonal or anti-inflammatory treatments in the 3 months prior to surgery to allow unbiased preoperative HRQoL assessment. Those requiring immediate medical treatment for severe symptoms were excluded to minimize confounding factors. Inclusion criteria included women with a confirmed diagnosis of endometriosis scheduled for laparoscopic surgery. The primary indications for laparoscopic surgery included chronic pelvic pain, infertility, and recurrence of endometriotic lesions that did not respond to medical treatment. These patients were scheduled for laparoscopic surgery to alleviate symptoms and improve fertility outcomes. Postoperative histopathological examination was required to confirm the diagnosis of endometriosis in all included participants. Endometriosis was confirmed in all participants through laparoscopic visualization and histopathological examination. Preoperative imaging, including transvaginal ultrasound and/or pelvic MRI, was performed to support clinical suspicion and facilitate surgical planning. Exclusion criteria included recent use of hormones or anti-inflammatory drugs within 3 months before surgery, confirmed gynecological malignancies, acute inflammation, pregnancy, or perimenopausal/postmenopausal status, or severe symptoms necessitating urgent treatment. Each participant was assessed using the Endometriosis Health Profile-30 (EHP-30) questionnaire 4 weeks before surgery and 3 months after surgery to obtain preoperative and postoperative subscale scores. Study outcomes The primary outcome of this study was the change in HRQoL scores, measured by the Endometriosis Health Profile-30 (EHP-30), before and after laparoscopic surgery. Secondary outcomes included correlations between preoperative serum CA125 levels, intraoperative rASRM scores, and changes in HRQoL scores across various subscales. These outcomes were chosen to evaluate the effectiveness of laparoscopic surgery and to identify potential predictors of HRQoL improvement. EHP-30 questionnaire The EHP-30 questionnaire was administered online through “Wenjuanxing”. “Wenjuanxing” is a widely used online survey platform in China that allows for easy distribution and completion of questionnaires. Four weeks before surgery, participants completed the questionnaire via a QR code. Three months postoperatively, participants were re-contacted via WeChat, a popular messaging and social media app in China, and instructed to complete the follow-up EHP-30 questionnaire using a new QR code, enabling the collection of post-surgery HRQoL data. The EHP-30 consists of a 30-item core survey and a 23-item module, covering 11 subscales: pain, control and powerlessness, emotional well-being, social support, self-image, work life, relationship with children, sexual intercourse, medical profession, treatment, and concern about infertility. Each response was scored from 0 (never) to 4 (always), with subscale scores calculated by summing raw scores, dividing by the maximum possible score, and multiplying by 100. Surgical procedure and data collection Laparoscopic surgery for endometriosis was performed according to standard clinical protocols, with disease severity assessed using the revised American Society for Reproductive Medicine (rASRM) staging system (Stage I: 1–5 points, Stage II: 6–15 points, Stage III: 16–40 points, Stage IV: > 40 points). Postoperative pathology confirmed endometriosis in all cases. Additionally, retrospective clinical data, including age, BMI, gravida, parity, infertility status, pain symptoms, serum CA125 levels, rASRM staging, and pathological results, were collected from the Hospital Information System (HIS). This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to ensure the quality and rigor of the study design and reporting. The completed STROBE checklist is provided as a supplementary file to demonstrate compliance with these standards. Ethics approval The study was approved by the Research Ethics Committee of Fujian Maternity and Child Health Hospital (grant number: 2021-KRD022). Informed consent was obtained from all participants. The appropriate norms and regulations were adhered to during the execution of all methods and procedures.

All 70 patients who were enrolled in this study and underwent laparoscopic surgery for endometriosis successfully completed the EHP-30 questionnaire. The mean age of the participants was 33.06 ± 6.63 years. Baseline demographic and clinical characteristics are detailed in Table 1 . Of these patients, 50% had no history of pregnancy, 62.86% were nulliparous, and 42.86% had a history of infertility. Pain-related symptoms were prevalent, with 71.67% reporting lower abdominal pain during menstruation, 18.57% experiencing chronic pelvic pain, and 34.29% reporting dyspareunia. The mean preoperative serum CA125 level was 82.04 ± 66.92. The median EHP-30 total scores were 25.00 preoperatively and 10.15 postoperatively, indicating a significant reduction in symptom burden following surgery. Table 1 Baseline characteristics of the patients with endometriosis. Variable Samples(N = 70) Age 33.06 ± 6.63 BMI 21.01 ± 2.44 Gravida 0 35(50.00%)   ≥ 1 35(50.00%) Parity 0 44(62.86%)   ≥ 1 26(37.14%) Infertility Primary infertility 24(34.29%) Secondary infertility 6(8.57%) Pain symptom Dysmenorrhoea 43(71.67%) Chronic pelvic pain 13(18.57%) Dyspareunia 24(34.29%) CA125 82.04 ± 66.92 rASRM stage Stage I 5(7.14%) Stage II 1(1.43%) Stage III 19(27.14%) Stage IV 45(64.29%) Endometriotic phenotype Superficial peritoneal endometriosis (SUP) 52(74.29%) Ovarian endometrioma (OMA) 61(87.14%) Deeply infiltrating endometriosis (DIE) 8(11.43%) Overall EHP-30 scores Preoperation 25.00(15.57, 36.91) Postoperation 10.15(3.18, 20.75) Data are expressed as mean ± standard deviation, number (percentage) of patients, median (quarter median, three-fourths median). \ BMI, body mass index; CA125, cancer antigen 125; rASRM stage, revised American Society for Reproductive Medicine; EHP-30 (Endometriosis Health Profile-30). Data are shown as median (quarter median- three-fourths median). Baseline characteristics of the patients with endometriosis. Data are expressed as mean ± standard deviation, number (percentage) of patients, median (quarter median, three-fourths median). \ BMI, body mass index; CA125, cancer antigen 125; rASRM stage, revised American Society for Reproductive Medicine; EHP-30 (Endometriosis Health Profile-30). Data are shown as median (quarter median- three-fourths median). Statistical analysis revealed significant reductions in overall EHP-30 scores following surgery ( P  < 0.001) (Table 2 ). Notable decreases were observed across all EHP-30 core subscales, including pain, control and powerlessness, emotional well-being, social support, and self-image (all P  < 0.001). Similarly, substantial reductions were seen in the EHP-30 module subscales, such as work life (all P  < 0.001), relationship with children ( P  = 0.002), sexual intercourse (all P  < 0.001), medical profession ( P  = 0.001), treatment (all P  < 0.001), and concern about infertility (all P  < 0.001). The box plot in Fig.  1 and Fig.  2 visually represents these changes, highlighting the marked improvement in HRQoL among patients with endometriosis. Table 2 Preoperative score and postoperative score of each EHP-30 subscale. Preoperative score Postoperative Score P value Overall 25.00 (15.57, 36.91) 10.15 (3.18, 20.75)  < 0.0001 Pain 27.27 (9.09, 47.73) 0.00 (0.00, 14.78)  < 0.0001 Control and powerlessness 33.33 (8.33, 50.00) 8.33 (0.00, 25.00)  < 0.0001 Emotional well-being 29.17 (16.67, 41.88) 14.59 (0.00, 25.00)  < 0.0001 Social support 25.00 (6.25, 45.31) 0.00 (0.00, 25.00)  < 0.0001 Self-image 8.33 (0.00, 25.00) 0.00 (0.00, 16.67) 0.0037 Work life 15.00 (5.00, 30.00) 0.00 (0.00, 15.00)  < 0.001 Relationship with children 0.00 (0.00, 15.62) 0.00 (0.00, 0.00) 0.044 Sexual intercourse 20.00 (0.00, 30.00) 0.00 (0.00, 21.25) 0.0017 Medical profession 0.00 (0.00, 6.25) 0.00 (0.00, 0.00) 0.0168 Treatment 25.00 (0.00, 42.36) 8.33 (0.00, 33.33) 0.0232 Concern on infertility 37.50 (0.00, 78.13) 18.75 (0.00, 50.00) 0.1544 Data are expressed as median (quarter median, three-fourths median). Fig. 1 Changes in HRQoL subscale scores before and after laparoscopic surgery. Note: **** P  < 0.0001 indicates a statistically significant difference, ** P  < 0.01 indicates a highly significant difference. Fig. 2 Preoperative score and postoperative score of each EHP-30 module subscale. Note **** P  < 0.0001 indicates a statistically significant difference, ** P  < 0.01 indicate a highly significant difference.* P  < 0.05 indicate a significant difference. Ns indicates a non-statistically significant difference. Preoperative score and postoperative score of each EHP-30 subscale. Data are expressed as median (quarter median, three-fourths median). Changes in HRQoL subscale scores before and after laparoscopic surgery. Note: **** P  < 0.0001 indicates a statistically significant difference, ** P  < 0.01 indicates a highly significant difference. Preoperative score and postoperative score of each EHP-30 module subscale. Note **** P  < 0.0001 indicates a statistically significant difference, ** P  < 0.01 indicate a highly significant difference.* P  < 0.05 indicate a significant difference. Ns indicates a non-statistically significant difference. Table 3 demonstrates a statistically significant positive correlation between serum CA125 levels and preoperative EHP-30 pain subscale scores ( R  = 0.334, P  = 0.005). However, the correlation between serum CA125 levels and the overall EHP-30 score, as well as other subscales, was not statistically significant. In contrast, Table 4 reveals that intraoperative rASRM scores were significantly positively correlated with preoperative EHP-30 pain subscale scores ( R  = 0.263, P  = 0.035) and sexual intercourse subscale scores ( R  = 0.240, P  = 0.046). No statistically significant correlations were observed between rASRM scores and other EHP-30 subscales. Table 3 The correlation between CA125 and preoperative score of EHP-30 subscale. Preoperative score of each subscale R value P value Overall 0.080 0.509 Pain 0.334 0.005 Control and powerlessness 0.128 0.290 Emotional well-being – 0.059 0.629 Social support 0.080 0.511 Self-image – 0.047 0.698 Work life 0.113 0.350 Relationship with children 0.055 0.648 Sexual intercourse – 0.085 0.483 Medical profession – 0.230 0.056 Treatment – 0.147 0.224 Concern on infertility – 0.001 0.992 Bold values indicate p  < 0.05. Table 4 The correlation between rASRM scores and preoperative score of each EHP-30 subscale. Preoperative score of each subscale R value P value Overall 0.120 0.323 Pain 0.263 0.035 Control and powerlessness 0.094 0.440 Emotional well-being 0.006 0.963 Social support 0.024 0.843 Self-image -0.020 0.868 Work life 0.126 0.297 Relationship with children 0.155 0.201 Sexual intercourse 0.240 0.046 Medical profession -0.063 0.607 Treatment 0.088 0.469 Concern on infertility -0.078 0.523 Bold values indicate p  < 0.05. The correlation between CA125 and preoperative score of EHP-30 subscale. Bold values indicate p  < 0.05. The correlation between rASRM scores and preoperative score of each EHP-30 subscale. Bold values indicate p  < 0.05. Table 5 presents the Spearman correlations of changes (Δ) in subscale scores for the 70 patients who underwent laparoscopic surgery for endometriosis. Changes in pain scores (ΔPain) exhibited significant positive correlations with changes in control and powerlessness, emotional well-being, and work life scores, with all correlations reaching statistical significance ( P  < 0.01). Similarly, changes in control and powerlessness were strongly correlated with changes in emotional well-being, social support, and work life scores, all showing statistically significant relationships ( P  < 0.01). Positive correlations were also observed between changes in emotional well-being and changes in social support, work life, and sexual intercourse scores, with each correlation being statistically significant ( P  < 0.01). Furthermore, changes in social support were significantly correlated with improvements in self-image, work life, and relationship with children scores ( P  < 0.01). Changes in self-image were significantly correlated with changes in medical profession scores ( P  < 0.01). Lastly, changes in work life were strongly correlated with changes in relationship with children scores ( P  < 0.01), and changes in sexual intercourse were significantly correlated with changes in concern about infertility scores ( P  < 0.01). Table 5 Correlation between preoperative and postoperative changes in the scores of each EHP-30 subscale. ΔPain ΔControl and powerlessness ΔEmotional well-being ΔSocial support ΔSelf-image ΔWork life ΔRelationship with children ΔSexual intercourse ΔMedical profession ΔTreatment ΔConcern on infertility ΔPain 0.507** 0.358** 0.246* 0.067 0.541** 0.287* -0.062 -0.084 -0.153 -0.178 ΔControl and powerlessness 0.507** 0.656** 0.569** 0.234 0.564** 0.270* 0.271* -0.041 0.092 0.149 ΔEmotional well-being 0.358** 0.656** 0.485** 0.197 0.573** 0.300* 0.331** -0.046 0.256* 0.053 ΔSocial support 0.246* 0.569** 0.485** 0.465** 0.372** 0.364** 0.078 0.118 0.288* 0.106 ΔSelf-image 0.067 0.234 0.197 0.465** 0.208 0.250* 0.052 0.313** 0.177 0.178 ΔWork life 0.541** 0.564** 0.573** 0.372** 0.208 0.415** 0.151 0.056 0.040 0.216 ΔRelationship with children 0.287* 0.270* 0.300* 0.364** 0.250* 0.415** 0.061 -0.016 0.156 0.033 ΔSexual intercourse -0.062 0.271* 0.331** 0.078 0.052 0.151 0.061 0.030 0.232 0.460** ΔMedical profession -0.084 -0.041 -0.046 0.118 0.313** 0.056 -0.016 0.030 0114 0.203 ΔTreatment -0.153 0.092 0.256* 0.288* 0.177 0.040 0.156 0.232 0.141 0.185 ΔConcern on infertility -0.178 0.149 0.053 0.106 0.178 0.216 0.033 0.460** 0.203 0.185 * P  < 0.05 ** P  < 0.01. Correlation between preoperative and postoperative changes in the scores of each EHP-30 subscale. * P  < 0.05 ** P  < 0.01. Table 6 presents the results of the multivariate linear regression analysis, focusing on the statistically significant Spearman correlations between preoperative and postoperative changes in EHP-30 subscale scores. The analysis revealed that changes in pain scores (ΔPain) were significantly associated with changes in control and powerlessness ( B  = 0.470, P  < 0.01) and work life ( B  = 0.421, P  < 0.01). Furthermore, changes in control and powerlessness (ΔControl and Powerlessness) showed significant associations with changes in pain ( B  = 0.367, P  < 0.01) and emotional well-being ( B  = 0.530, P  < 0.01). Changes in emotional well-being (ΔEmotional Well-being) were significantly correlated with changes in control and powerlessness ( B  = 0.394, P  < 0.01) and work life ( B  = 0.292, P  < 0.01). Similarly, changes in social support (ΔSocial Support) were significantly associated with changes in self-image ( B  = 0.311, P  < 0.01) and treatment ( B  = 0.277, P  < 0.01). Additionally, changes in self-image (ΔSelf-image) were significantly correlated with changes in social support ( B  = 0.318, P  < 0.01) and relationship with children ( B  = 0.268, P  < 0.05). Changes in work life (ΔWork Life) were significantly associated with changes in pain ( B  = 0.272, P  < 0.01), emotional well-being ( B  = 0.403, P  < 0.01), and relationship with children ( B  = 0.203, P  < 0.05). Changes in sexual intercourse (ΔSexual Intercourse) were significantly correlated with changes in concern about infertility (B = 0.373, P  < 0.01). Similarly, changes in treatment (ΔTreatment) showed significant associations with changes in social support ( B  = 0.409, P  < 0.05). Changes in concern about infertility (ΔConcern on Infertility) were significantly associated with changes in sexual intercourse ( B  = 0.408, P  < 0.01). However, there were no statistically significant factors influencing changes in relationship with children (ΔRelationship with Children) and medical profession (ΔMedical Profession). Table 6 Multivariate linear regression analysis of preoperative and postoperative changes in the scores of each EHP-30 subscale. ΔPain ΔControl and powerlessness ΔEmotional well-being ΔSocial support ΔSelf-image ΔWork life ΔRelationship with children ΔSexual intercourse ΔMedical profession ΔTreatment ΔConcern on infertility ΔPain 0.367** -0.023 -0.065 0.272** 0.163 ΔControl and powerlessness 0.470** 0.394** 0.215 0.039 -0.101 0.147 ΔEmotional well-being -0.115 0.530** 0.066 0.403** 0.111 0.053 -0.044 ΔSocial support -0.201 0.185 0.064 0.318** 0.157 0.172 0.409* ΔSelf-image 0.311** 0.257 0.231 ΔWork life 0.421** 0.031 0.292** 0.157 0.290 ΔRelationship with children 0.141 -0.069 0.064 0.130 0.268* 0.203* ΔSexual intercourse 0.212 0.074 0.408** ΔMedical profession 0.289 ΔTreatment 0.047 0.227** ΔConcern on infertility 0.053 0.373** * P  < 0.05, ** P  < 0.01. Multivariate linear regression analysis of preoperative and postoperative changes in the scores of each EHP-30 subscale. * P  < 0.05, ** P  < 0.01.

Endometriosis is a chronic gynecological condition characterized by the presence of endometrial-like tissue outside the uterus, leading to debilitating symptoms such as chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility 1 . Affecting approximately 10% of women of reproductive age, this condition profoundly impacts quality of life (QoL), encompassing physical, emotional, and social domains 12 . Given the widespread and multifaceted impact of endometriosis, effective treatment strategies are essential to alleviate symptoms and improve health-related quality of life (HRQoL). Laparoscopic surgery is a pivotal tool in the management of endometriosis, offering not only minimally invasive access but also advanced visualization techniques that significantly enhance surgical precision. The use of indocyanine green (ICG) fluorescence imaging and 3D visualization systems allows for better magnification and delineation of pathological lesions, thereby optimizing surgical outcomes 29 . These technologies provide an improved ability to differentiate between healthy and diseased tissues, enabling precise lesion excision while minimizing damage to surrounding structures. White light imaging, while commonly used in laparoscopic surgery, has significant limitations in detecting occult endometriotic lesions. Small, deeply infiltrating, or poorly vascularized lesions may be overlooked under standard visualization, potentially leading to residual disease. These remnants can contribute to persistent symptoms, increased recurrence rates, and a diminished quality of life post-surgery. Advanced imaging techniques, such as ICG fluorescence imaging and 3D visualization systems, offer substantial advantages in overcoming these limitations. ICG fluorescence imaging enhances lesion detection by highlighting vascularized tissues, enabling more precise differentiation between healthy and diseased areas 29 . Similarly, 3D visualization systems improve depth perception and accuracy during complex dissections, particularly in cases involving deep infiltrating endometriosis. These technologies not only aid in reducing occult remnant disease but also contribute to the preservation of critical structures, such as pelvic nerves, minimizing complications and enhancing overall surgical outcomes. Moreover, laparoscopic surgery provides superior appraisal of pelvic anatomy, which is critical in preserving delicate nervous structures. The ability to carefully identify and protect these structures is particularly relevant in cases involving deep infiltrating endometriosis, where the risk of nerve damage is substantial 30 . This underscores the dual benefit of laparoscopic surgery: enhancing surgical outcomes while safeguarding functional integrity. These advancements highlight the importance of integrating modern imaging techniques into laparoscopic procedures, paving the way for improved quality of life and reduced postoperative complications for patients with endometriosis. Advanced surgical techniques, such as fluorescence-guided imaging and 3D visualization, significantly enhance surgical precision and outcomes but may raise concerns about their economic and ecological sustainability. These technologies often require high-cost equipment and generate substantial disposable surgical waste, contributing to environmental challenges. Efforts to balance innovation with affordability and ecological responsibility, such as adopting reusable instruments and optimizing operating room energy use, are increasingly important in modern surgical practice 31 . These results align with previous findings, but importantly, this study offers a more nuanced understanding of how specific HRQoL domains interact and improve post-surgery. Laparoscopic surgery, while highly effective in improving QoL for endometriosis patients, is not without risks. Potential anatomical and functional complications, such as pelvic adhesions, nerve damage, or altered function of pelvic organs, can occur. These complications may lead to chronic pelvic pain, reduced mobility, or disruptions in bowel and bladder function, which could negatively affect postoperative QoL 32 . For example, unintended damage to the pelvic nerves during excision of deep infiltrating endometriosis could result in neuropathic pain or sexual dysfunction, undermining the improvements in pain relief and emotional well-being typically achieved through surgery. Similarly, the formation of postoperative adhesions could limit mobility and exacerbate discomfort, partially offsetting the QoL benefits gained. These considerations highlight the need for meticulous surgical techniques and preoperative counseling to minimize complications and manage patient expectations. The positive correlations between preoperative serum CA125 levels, intraoperative rASRM scores, and preoperative pain highlight the importance of these biomarkers in clinical assessment. Elevated CA125 levels and higher rASRM scores were associated with increased pain, reinforcing their use in stratifying patients for targeted surgical intervention. These findings are consistent with established literature that validates CA125 as a biomarker for disease severity 33 , 34 . Additionally, the association between rASRM scores and pain underscores the utility of this staging system in clinical decision-making, further advocating for its integration into routine preoperative evaluations 35 . The multivariate regression analysis provided deeper insights into the interconnections between various HRQoL dimensions. Notably, improvements in pain were closely linked with better control and powerlessness, as well as enhanced work life, indicating that alleviating physical symptoms can directly influence patients’ sense of autonomy and professional engagement. This underscores the necessity for a comprehensive treatment approach that addresses both physical and psychosocial aspects of endometriosis 36 . Furthermore, the relationship between emotional well-being and control underscores the importance of psychological interventions. Enhancing patients’ sense of control and reducing feelings of powerlessness are crucial for improving emotional outcomes, suggesting that integrating mental health support into endometriosis care could yield significant benefits 37 , 38 . The interconnected nature of HRQoL domains, such as the links between emotional well-being, work life, and control, emphasizes the need for a multidisciplinary approach to care that addresses these interdependencies holistically 39 , 40 . Social support emerged as a critical factor influencing self-image and treatment perception, suggesting that strengthening social networks can significantly improve HRQoL outcomes. The close correlation between self-image and supportive relationships further highlights the role of family and community in patient recovery. These findings suggest that future interventions should focus not only on the patient but also on their broader support systems, to foster a more holistic recovery 41 , 42 . The associations between work life and changes in pain, emotional well-being, and relationships with children illustrate the broad impact of endometriosis management. Effective pain relief and emotional support have far-reaching effects beyond symptom control, improving professional and personal life dimensions. This finding underscores the importance of comprehensive pain management strategies within endometriosis care 43 , 44 . Moreover, the influence of infertility concerns on sexual health underscores the significant psychological burden these patients face. Addressing reproductive health concerns within the treatment framework is crucial for improving both sexual and emotional well-being 45 , 46 . One of the strengths of this study is the use of the EHP-30 questionnaire, a tool specifically designed for endometriosis patients, enabling a nuanced assessment of how surgery impacts HRQoL. However, this study’s limitations include a relatively small sample size and short follow-up period, which may affect the generalizability of the findings. Larger, longitudinal studies are needed to confirm these results and explore the long-term effects of laparoscopic surgery. Additionally, comparative studies of different laparoscopic techniques could identify the most effective strategies for individualized patient care. In conclusion, laparoscopic surgery significantly improves HRQoL in endometriosis patients by reducing pain and enhancing various aspects of daily life and emotional well-being. This highlights the critical role of surgical intervention as part of a comprehensive treatment plan that also addresses psychological and social dimensions. A multidisciplinary approach, integrating surgical, medical, and psychological support, is essential for optimizing patient outcomes. Future research should focus on refining these strategies and exploring the long-term benefits of such integrated care.

Statistical analyses were conducted using SPSS software version 22.0 (SPSS Inc., Chicago, IL, USA). Continuous variables are presented as mean ± standard deviation or median with interquartile range, as appropriate. The Wilcoxon signed-rank test was employed to compare EHP-30 scores before and after surgery. Spearman correlation analysis was used to evaluate the relationships between preoperative serum CA125 levels and preoperative EHP-30 scores, intraoperative rASRM scores and preoperative EHP-30 scores, as well as changes in subscale scores following laparoscopic surgery. For variables that showed statistical significance, further multivariate linear regression analysis was conducted to elucidate the interrelationships. Statistical significance was defined as a p -value of less than 0.05.

Endometriosis is a chronic gynecological condition affecting approximately 5% to 10% of women of reproductive age and is a leading cause of infertility, affecting up to 50% of patients 1 – 4 . It is characterized by the presence of endometrial-like tissue outside the uterine cavity, causing symptoms such as chronic pelvic pain, dysmenorrhea, and dyspareunia 1 , 2 . The diagnosis is primarily confirmed through laparoscopy and histopathological examination, often supplemented by imaging modalities like ultrasound or MRI and biomarkers such as CA125 5 – 8 . Beyond its physical symptoms, endometriosis has profound impacts on health-related quality of life (HRQoL), disrupting daily activities, impairing work efficiency, and affecting mental well-being 9 – 12 . Laparoscopic surgery is a cornerstone treatment for endometriosis, offering precise lesion removal and faster recovery compared to traditional surgical approaches. This minimally invasive technique not only alleviates pain but also improves fertility outcomes and addresses complications from advanced-stage disease 15 – 18 . In addition to surgery, pharmacological treatments, including NSAIDs, oral contraceptives, GnRH agonists, and progestins like dienogest, play a critical role in managing symptoms and preventing disease recurrence 19 – 21 . However, the recurrent nature of endometriosis—40% to 50% within 2–5 years—necessitates comprehensive treatment strategies that address both symptoms and HRQoL 13 , 14 . Assessing HRQoL in endometriosis patients requires specific tools to capture the unique impact of the disease. While general instruments like the SF-36 are widely used, they lack disease specificity and may overlook important dimensions 22 – 25 . The Endometriosis Health Profile-30 (EHP-30), a validated, endometriosis-specific scale with 11 subscales, provides a comprehensive assessment of HRQoL and is widely applied in clinical research 26 – 28 . Its sensitivity to changes in HRQoL makes it an ideal tool for evaluating therapeutic interventions. In this study, we utilize the EHP-30 to evaluate the changes in HRQoL before and after laparoscopic surgery in patients with endometriosis. This study aims to assess the effectiveness of laparoscopic surgery as an intervention and explore correlations between disease severity, preoperative HRQoL scores, and postoperative outcomes, providing a comprehensive understanding of its impact on various dimensions of HRQoL.