Quality of Life and Psychological Comorbidities in Endometriosis and Adenomyosis: A Prospective Observational Study Using Advanced Ultrasound

OBJECTIVE: This study aimed to assess whether the presence of endometriosis and/or adenomyosis on advanced ultrasound accounts for variations in quality of life. Our secondary objective was to examine potential determinants of quality of life in this population. METHODS: This prospective observational study was conducted at a tertiary referral center for pelvic pain (Laval University Hospital Center, Canada) from March 2021 to December 2024. Premenopausal patients aged 18 years or older with pelvic pain in the presence of endometriosis and/or adenomyosis lesions diagnosed by advanced ultrasound were included. Data were collected via questionnaires and validated tools, including the EPHectEPQ, EHP-30, GAD-7, PHQ-9 and others. RESULTS: Of the 180 eligible participants, 43% (77/180) had endometriosis, 19% (34/180) had adenomyosis and 38% (69/180) had both. No significant differences were observed in quality of life between groups (EHP-30 mean: 53.1 ± 26.4, P = 0.82). Analysis of quality of life revealed that anxiety (β = 17.6), depression (β = 14.7), pain catastrophizing (β = 10.3), central sensitization (β = 8.3) and dysmenorrhea (β = 8.1) were the most important determinants affecting quality of life. Dyschezia (β = 5.5), no diagnosis prior to ultrasound (β = 4.6), dyspareunia (β = 4.2) and chronic pelvic pain (β = 4.1) were also significant determinants. CONCLUSION: Presence of adenomyosis, endometriosis or both on advanced ultrasound fails to explain variations in quality of life of patients with pelvic pain. Anxiety, depression, pain catastrophizing, central sensitization and dysmenorrhea seem to be important factors affecting quality of life. These results highlight the complex interplay of psychological and physical factors in determining quality of life in patients with endometriosis and/or adenomyosis.