Évaluation de la qualité de vie chez les femmes traitées pour endométriose profonde : stratégie médicale versus stratégie chirurgicale

Introduction: endometriosis is a disease that directly affects women’s daily life. Assessing the impact of this disease and the treatments on their quality of life is essential in the choice of therapeutic strategy. At the moment, there is no consensus on the preferred therapeutic method. The main objective of our study is to define whether the first-line medical strategy is as effective as the surgical strategy in terms of quality of life. Method: in this observational study, 101 women with deep endometriosis were included: 52 received first-line medical treatment (M1) and 49 received first-line surgery (C1). Patients answered a questionnaire that included several validated scores : Endometriosis Health Profile-5 (EHP-5), Knowles-Eccersley-Scott Symptom score (KESS), Female Sexual Function Index (FSFI), and overall life (EAN). The primary outcome was the results on quality of life scores. The impact of digestive disorders and the effect of time on therapeutic efficacy were also evaluated. Prognostic factors in the response to treatment were assessed. Results: women who benefit from first-line surgery had significantly better quality of life scores for EHP-5, KESS and FSFI (respectively p = 0.032, p = 0.035, p = 0.049). There was no difference on the EAN (p = 0.4). Without gastrointestinal lesion, there was no significant difference on the scores between therapeutic strategies. Patients with gastrointestinal lesion who benefit from surgery had significantly better EHP-5 and KESS scores (p = 0.02 and p = 0.038). There was no difference on the FSFI (p = 0.113) and the EAN (p = 0.342). Patients treated by surgery for more than 36 months had a better quality of life. No correlation was found between the age of the patients and their response to treatment. The primiparous or multiparous patients had better quality of life scores. Conclusion: we found no difference in terms of quality of life between therapeutic strategies for patients with deep endometriosis without digestive localisation. On the other hand, women with digestive endometriosis receiving a surgical treatment have a better quality of life. Randomized comparative studies are needed to determine the best therapeutic approach in the treatment of digestive endometriosis.