Clinical features of pain syndrome in endometriosis during wartime: experience of internally displaced women and female combatants

The objective: to evaluate the clinical course of genital endometriosis and severity of pain and psycho-emotional symptoms in women whose lives have been directly affected by war (servicewomen and internally displaced persons (IDPs)) compared with civilian women without military experience.Materials and methods. This study included 269 women aged 18–55 years (41.8 ± 8.4 years) with a confirmed diagnosis of endometriosis based on surgical visualization and/or histological verification of lesions, or typical findings on ultrasound or magnetic resonance imaging. 3 groups of participants were formed: I group – 55 servicewomen; II group – 103 women who are IDPs; control group (CG) – 111 civilian women without war-related exposure. Pain intensity and clinical signs of endometriosis were assessed using the Biberoglu and Behrman Scale, while anxiety and depression levels were evaluated with the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was performed using one-way analysis of variance (ANOVA) with Tukey post-hoc test and Pearson’s χ2 test (p < 0.05).Results. The participants in the I and II groups demonstrated significantly higher intensity of pelvic pain, dysmenorrhea, dyspareunia and higher total scores on the Biberoglu and Behrman Scale compared with women in CG. I group had the highest scores for pelvic tenderness and objective physical signs (firmness and tenderness on palpation), whereas II group – the highest total scores for symptoms and signs. According to HADS, the proportion of women with clinically significant anxiety and depression was significantly higher in I and II groups than in CG; the highest rates of clinical anxiety (39.8%) and depression (33.9%) observed in the II group.Conclusions. War is associated with a more severe course of endometriosis in women involved in military service or who are internally displaced, which is manifested by increased pain intensity, more pronounced infiltrative forms and a high prevalence of anxiety and depressive disorders. These findings highlight the need for a comprehensive multidisciplinary approach to the management of women with endometriosis in war settings, including routine psycho-emotional screening and targeted medical and psychological support programs.