Opioids for management of endometriosis associated pain: balancing effectiveness and quality of life

Objective To identify risk factors for opioid use and assess the effect of opioids on women with endometriosis. Design A retrospective cohort study. Setting A tertiary medical center. Participants Women with confirmed or suspected endometriosis aged 18–45 years.

Recruited participants completed a questionnaire including baseline demographic and general health data, a Brief Pain Inventory (BPI-Heb) and a Visual Analogue Scale assessing Endometriosis associated pain symptoms. Women using opioids were compared to women not using opioids. Women treated with opioids further completed a Visual Analogue Scale quesionniare of pain symptoms after using opioids, a questionnaire assessing side effects, and the Opioid Risk Tool for the assessment of addiction risk.

Ninety-eight patients were included in the study. Of them, 49 were opioid users, and 49 were non-opioid users. One unit increase in overall pain was associated with a 28% increased risk of opioid use [OR = 1.28, 95% CI 1.1–1.5, p = .007]. Use of hormonal therapy and smoking also increased opioid use risk [OR = 6.16, 95% CI 1.7–22.5, p = 0.006, OR = 4.36, 95% CI 1.2–16.1, p = .027, respectively]. Within the opioid users group, all pain symptoms and quality of life domains were significantly improved, with the most significant improvement demonstrated in dysmenorrhea and sleeping quality (median change: -4.5 (p < .001) and 5 (p < .001) points, respectively). While there were no life-threatening side effects, 94% of women using opioids experienced at least one side effect and 33% had moderate to high risk of addiction.

In our study, the risk of opioid use among women with endometriosis was increased for women with hormonal therapy, smoking and higher pain severity. While opioids were associated with high rates of side effects, they were effective pain relievers and overall quality of life was improved. More research is needed to delineate better the role and risks of opioids for the treatment of endometriosis associated pain. Similar content being viewed by others Data availability The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request. Abbreviations - BPI-Heb: - Brief Pain Inventory – Hebrew version - CI: - Confidence interval - EAP: - Endometriosis-associated pain - IQR: - Interquartile range - NMPP: - Non-menstrual pelvic pain - NSAIDs: - Non-steroidal anti-inflammatory drugs - OR: - Odds ratio - ORT: - Opioid Risk Tool - SD: - Standard deviation - VAS: - Visual analogue scale

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The authors thank the staff of the Endometriosis Center at Hadassah Medical Center for their assistance with patient recruitment and data collection. Prior presentation Preliminary results of this study were presented (poster) at the 15th World Congress on Endometriosis, Edinburgh, Scotland, 2023. IRB approval The study was approved in August 2022 by the Hadassah Medical Center Ethics Committee in accordance with the Declaration of Helsinki (Approval No. HMO-22-0305). Funding The authors declare that no specific funding was received for this study. Author information Authors and Affiliations Contributions Yael Roza Douak and Nir Cohen contributed equally to this work. Yael Roza Douak and Nir Cohen conceived the study and contributed to the study design. Nir Cohen and Tal Saar were responsible for patient recruitment and data collection. Ilan Matok contributed to data analysis and interpretation. Uri Dior supervised the study. Nir Cohen drafted the manuscript, and all authors critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript. Corresponding author Ethics declarations Ethics approval and consent to participate The study was approved by the Hadassah Medical Center Ethics Committee in accordance with the Declaration of Helsinki (Approval No. HMO-22-0305). Written informed consent was obtained from all participants prior to study participation. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Douak, Y.R., Cohen, N., Matok, I. et al. Opioids for management of endometriosis associated pain: balancing effectiveness and quality of life. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04423-0 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04423-0