Impact of the COVID-19 pandemic on patients affected by endometriosis: A questionnaire-based cross-sectional online survey

Introduction:

Results:

Introduction

Recruitment Data collection and assessment Data analysis Statistical analysis

| Patient characteristics | n = 105 | | Age (years): mean ± SD | 37.36 ± 8.17 | | Employment status (working) n (%) | 61 (58.7) | | Educational level: n (%) | | | Lower secondary education High school diploma Postgraduate degree University degree | 22 (21.2%) 46 (44.2%) 7 (6.7%) 29 (27.9%) | | Marital status (living with partner/married) n (%) | 62 (59.6%) | | Current weight (kg): mean ± SD | 61.02 ± 13.00 | | Height (cm): mean ± SD | 161.83 ± 6.65 | | Smoking status: n (%) | | | Non-smoker Smokes traditional cigarettes Uses electronic cigarette | 86 (81.9%) 16 (15.2%) 3 (2.9%) | | Pain and menstruation | | | Age at first menstruation (years): mean ± SD | 12.02 ± 1.45 | | Menstruation (currently painful): no = n (%) | 48 (45.7%) | | Menstruation (always been painful): yes = n (%) | 82 (78.1%) | | Duration of painful menstruation if not always (years): mean ± SD | 7.38 ± 5.16 | | Use of analgesics for menstrual pain: no = n (%) | 38 (36.2%) | | Use of analgesics for chronic pelvic pain: no = n (%) | 58 (55.2%) | | Number of analgesics for chronic pelvic pain during the month: mean ± SD | 5.92 ± 7.25 | | Use of GnRH analog hormonal therapy: no = n (%) | 61 (58.1%) | | Duration of pharmacological menopause (months): mean ± SD | 25.25 ± 25.43 | | Use of contraceptive Pill hormonal therapy: yes = n (%) | 65 (61.9%) | | Duration of taking the pill (months): mean ± SD | 76.90 ± 105.87 | | Method of hormonal therapy (monthly pause): yes = n (%) | 3 (4.6%) | | Menstruation regularity without contraceptive Pill: Regular = n (%) | 16 (64.0%) | | Endometriosis and surgeries | | | Undergone surgeries for endometriosis: yes = n (%) | 51 (48.6%) | | Number of surgeries undergone: mean ± SD | 1.96 ± 2.95 | | Year of first surgery: mean ± SD | 2010.12 ± 6.81 | | Year of second surgery: mean ± SD | 2011.21 ± 6.07 | | Undergone intestinal derivation/resection during surgery: yes = n (%) | 5 (10.9%) | | Undergone removal of a fallopian tube and ovary during surgery: yes = n (%) | 4 (8.5%) | | Undergone removal of both fallopian tubes and ovaries during surgery: yes = n (%) | 2 (4.3%) | | Undergone other procedures during surgery: no = n (%) | 19 (44.2%) | | Other pathologies beyond endometriosis: yes = n (%) | 55 (52.4%) | | Undergone surgeries for other pathologies beyond endometriosis in the last year: yes = n (%) | 8 (7.7%) | | Duration since endometriosis diagnosis (years): mean ± SD | 8.72 ± 9.47 | | Type of endometriosis diagnosed: n (%) | | | Ovarian Superficial Deep | 50 (48.1%) 11 (10.6%) 43 (41.3%) | | Fertility and pregnancy | | | Previous pregnancies: yes = n (%) | 38 (36.5%) | | Number of pregnancies: mean ± SD | 1.47 ± 0.73 | | Abortions: yes = n (%) | 26 (25.0%) | | Number of abortions: mean ± SD | 1.23 ± 0.51 | | Voluntary pregnancy interruptions (IVG): yes = n (%) | 7 (6.7%) | | Number of IVG: mean ± SD | 1.00 ± 0.00 | | Currently seeking pregnancy: yes = n (%) | 7 (6.7%) | | Duration of seeking pregnancy (months): mean ± SD | 98.00 ± 84.31 | | Resorted to assisted reproduction techniques: yes = n (%) | 6 (5.8%) | | Techniques used in assisted reproduction: n (%) | | | IUI (Intrauterine insemination) IVF (in vitro fertilization) ICSI (intracytoplasmic sperm injection) | 5 (27.8%) 4 (23.5%) 3 (16.7%) | | Symptoms and pain assessment in the last month | | | Dysmenorrhea (mean ± SD) | 3.93 ± 3.81 | | Chronic pelvic pain outside of menstruation: (mean ± SD) | 3.64 (3.32) | | Sexual intercourse: yes = n (%) | 71 (67.6%) | | Dyspareunia (mean ± SD) | 4.52 (3.09) | | Rectal pain: no = n (%) | 48 (45.7%) | | Rectal pain (mean ± SD) | 4.94 ± 3.39 | | Rectal tenesmus: no = n (%) | 62 (59.0%) | | Rectal dyschezia: no = n (%) | 44 (41.9%) | | Changes in bowel habits during menstruation: yes = n (%) | 49 (46.7%) | | Changes in bowel habits apart from menstruation: yes = n (%) | 52 (49.5%) | | Dysuria: no = n (%) | 73 (69.5%) | | Dysuria (mean ± SD) | 3.62 ± 3.67 | | Vescical tenesmus: no = n (%) | 42 (40.0%) | | Pollakiuria: no = n (%) | 53 (50.5%) | | Treatment and health care access | | | Waitlisted for surgery, n (%) | 6 (5.7) | | Needed to visit doctors for endometriosis: no = n (%) | 69 (65.7) | | Difficulty contacting doctors: yes = n (%) | 25 (23.8) | | Felt medical abandonment (mean ± SD) | 3.48 ± 3.27 | | Changes in pain due to COVID-19 health emergency n (%) | | | Decreased from the previous period Unchanged from the previous period Increased from the previous period | 25 (23.8) 64 (61.0) 16 (15.2) | | Increased pain average (mean ± SD) | 7.44 ± 1.89 | | Concerns and worries | | | Concerned about planning pregnancy (mean ± SD) | 3.45 ± 4.44 | | Concerned about economic factors (mean ± SD) | 6.50 ± 3.26 | | Concerned about personal/family factors (mean ± SD) | 6.99 ± 2.81 | | Concerned about pandemic factors (mean ± SD) | 6.30 ± 2.89 | | Concerned about being infected (mean ± SD) | 5.72 ± 3.20 | | Concerned about infecting the family (mean ± SD) | 7.08 ± 3.33 | | Concerned about family health (mean ± SD) | 8.33 ± 2.48 | | Concerned about difficulty to contact doctors (mean ± SD) | 5.13 ± 3.18 | | Concerned about about clinic closures (mean ± SD) | 6.01 ± 2.98 | | Concerned about waiting lists for new appointment (mean ± SD) | 6.79 ± 3.08 | | Concerned about starting new therapies for endometriosis (mean ± SD) | 5.45 ± 3.57 | | Scale | Mean ± SD | Median | Range | |---|---|---|---| | SF12 physical component summary (PCS12) | 41.4 ± 11.1 | 41.3 | 18.5–66.8 | | SF12 mental component summary (MCS12) | 39.3 ± 11.2 | 38.7 | 12.8–65.1 | | Hospital anxiety and depression scale (HADS) anxiety | 10.5 ± 4.4 | 10 | 0–20 | | HADS depression | 9.4 ± 3.5 | 9 | 2–21 | | HADS total | 19.9 ± 7.2 | 20 | 2–39 | | Endometriosis health profile-5 (EHP5) | 49.2 ± 19.5 | 48.8 | 0–91.2 | | Subjective sleep quality | 1.5 ± 0.7 | 1 | 0–3 | | Sleep latency | 1.4 ± 1.0 | 1 | 0–3 | | Sleep duration | 1.4 ± 1.0 | 2 | 0–3 | | Habitual sleep efficiency | 0.9 ± 1.1 | 0 | 0–3 | | Sleep disturbances | 1.7 ± 0.6 | 2 | 0–3 | | Use of sleeping medication | 0.6 ± 1.1 | 0 | 0–3 | | Sleep dysfunction | 0.3 ± 0.5 | 0 | 0–2 | | Global pittsburgh sleep quality index (PSQI) score | 7.8 ± 4.4 | 7 | 1–17 | | Variable 1 | Variable 2 | Spearman’s Rho | Significance | |---|---|---|---| | SF12 MCS | SF12 PCS12 | −0.018 | p = 0.859 | | HADS anxiety | SF12 PCS12 | −0.382 | p<0.001 | | SF12 MCS12 | −0.510 | p<0.001 | | | HADS depression | SF12 PCS12 | −0.287 | p = 0.003 | | SF12 MCS12 | −0.673 | p<0.001 | | | HADS Anxiety | 0.653 | p<0.001 | | | HADS total | SF12 PCS12 | −0.366 | p<0.001 | | SF12 MCS12 | −0.641 | p<0.001 | | | Subjective sleep quality | SF12 PCS12 | −0.284 | p = 0.003 | | SF12 MCS12 | −0.337 | p<0.001 | | | Sleep latency | SF12 PCS12 | −0.226 | p = 0.020 | | SF12 MCS12 | −0.238 | p = 0.014 | | | Sleep duration | SF12 PCS12 | −0.230 | p = 0.019 | | SF12 MCS12 | −0.252 | p = 0.010 | | | Habitual sleep efficiency | SF12 PCS12 | −0.405 | p<0.001 | | SF12 MCS12 | −0.244 | p = 0.013 | | | Sleep disturbance | SF12 PCS12 | −0.394 | p<0.001 | | SF12 MCS12 | −0.271 | p = 0.005 | | | Sleep dysfunction | SF12 PCS12 | −0.222 | p = 0.023 | | SF12 MCS12 | −0.276 | p = 0.004 | | | Global PSQI score | SF12 PCS12 | −0.407 | p<0.001 | | SF12 MCS12 | −0.345 | p<0.001 | | | EHP5 media standard | SF12 PCS12 | −0.591 | p<0.001 | | SF12 MCS12 | -0.321 | p<0.001 | | Cluster | Pain increased during COVID pandemic | Pain unchanged during COVID pandemic | Pain decreased during COVID pandemic | Rectal pain during the last month | Needed medical assistance during COVID pandemic | |---|---|---|---|---|---| | Cluster 1 Observed (n) | 5 | 37 | 12 | 21 | 9 | | Expected (n) | 12.9 | 32.9 | 8.23 | 29.3 | 18.5 | | % within row | 9.3 % | 68.5 % | 22.2 % | 38.9 % | 16.7 % | | Cluster 2 Observed (n) | 20 | 27 | 4 | 36 | 27 | | Expected (n) | 12.1 | 31.1 | 7.77 | 27.7 | 17.5 | | % within row | 39.2 % | 52.9 % | 7.8 % | 70.6 % | 52.9 % | | Health scale | Mean (SD) | Median | Min | Max | Comparison with normative data | Comparison with clinical data | |---|---|---|---|---|---|---| | SF12 PCS12 | 41.4 (11.1) | 41.3 | 18.5 | 66.8 | Facchini et al.47 H0 population mean ≠ 53.4 Student’s t = −11.1; df = 104; p<0.001 Cohen’s d = −1.08 | Vannucini et al.48 H0 population mean ≠ 41.5 Student’s t = −0.0834; df = 104; p = 0.934; Cohen’s d = 0.00814 | | SF12 MCS12 | 39.3 (11.2) | 38.7 | 12.8 | 65.1 | Facchini et al. 47 H0 population mean ≠ 43.4 Student’s t = −3.76; df = 104; p<0.001 Cohen’s d = −0.367 | Vannucini et al.48 H0 population mean ≠ 37. Student’s t = 1.94; df = 104; p = 0.055; Cohen’s d = 0.189 | | HADS anxiety | 10.5 (4.4) | 10 | 0 | 20 | Facchini et al.47 H0 population mean ≠ 6.49 Student’s t = 9.31 df = 104 p<0.001 Cohen’s d = 0.908 | Facchin et al.49 H0 population mean ≠ 7.5 Student’s t = 6.94; df = 104; p<0.001; Cohen’s d = 0.677 | | HADS depression | 9.4 (3.5) | 9 | 2 | 21 | Facchini et al.47 H0 population mean ≠ 4.71 Student’s t = 13.9; df = 104; p<0.001; Cohen’s d = 1.36 | Facchin et al.49 H0 population mean ≠ 6.1 Student’s t = 9.83; df = 104; p<0.001; Cohen’s d = 0.959 | | EHP-5 | 49.2 (19.5) | 48.8 | 0 | 91.2 | NA | Aubry et al.54 H0 population mean ≠ 48.1 Student’s t = 0.604; df = 104; p = 0.547; Cohen’s d = 0.0589 | | Global PSQI score | 7.8 (4.4) | 7 | 1 | 17 | NA | NA | | Proportion of patients with sleep problems (PSQ > 5) | 67% (70/105) | Leone Roberti Maggiore et al.53 H0 population proportion of women with sleep problems (Global PSQI score >5) ≠ 0.648 p = 0.759 |

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