Executive Functions Mediate Between Endometriosis Burden and Women’s Daily Life

Sewar Khatib, Haya Hassan, Suzan Abd Elgani, Ari Reiss, Batya Engel‐Yeger
In: International Journal of Women's Health · 2026 · vol. Volume 18 , pp. 1–16 · doi:10.2147/ijwh.s606990 · PMID:42261470 · W7163406675
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Women with endometriosis exhibit greater executive functioning difficulties, pain, and distress, with executive function mediating the link between disease burden and reduced quality of life and occupational balance.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This cross-sectional correlational study evaluated 103 women aged 18–35 (43 with clinically confirmed endometriosis recruited from a specialized clinic and 60 age-matched healthy controls) to compare executive functioning, disease burden, occupational balance, and quality of life, and to test whether executive functioning mediates links between burden and functional outcomes. Women with endometriosis reported significantly higher pain severity, pain catastrophizing, and emotional distress, along with greater executive-functioning difficulties, lower occupational balance, and reduced quality of life; within the endometriosis group, pain catastrophizing and emotional distress were associated with poorer executive functioning, which related to worse occupational balance and quality of life. Mediation analyses using Hayes’ PROCESS found that executive functioning fully mediated the associations between psychological disease burden (catastrophizing/emotional distress) and both occupational balance and quality of life, eliminating the direct effects after accounting for executive functioning. A key limitation is the cross-sectional design, which prevents conclusions about temporal or causal direction. This paper is centrally about endometriosis — it tests executive functioning as a mediating mechanism between endometriosis-related pain/psychological burden and disruptions in daily functioning and quality of life.

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Abstract

Purpose: To examine (1) group differences in executive functioning, disease burden, occupational balance and quality of life between women with endometriosis and healthy controls; (2) associations between pain-related and psychological disease burden -specifically pain catastrophizing and emotional distress- and occupational balance and quality of life; and (3) whether executive functioning mediates the relationships between disease burden and quality of life and occupational balance. Patients and Methods: This cross-sectional correlational study included 103 women aged 18-35 years, compromising 43 women with clinically confirmed endometriosis recruited from a specialized endometriosis clinic and 60 age-matched healthy controls. Disease burden was assessed using measures of pain severity (Visual Analog Scale - VAS), pain catastrophizing (Pain catastrophising scale -PCS), and emotional distress (Depression Anxiety Stress Scale - DASS21). Executive functioning (Barkley Deficits in Executive Functioning Scale-Short Form -BDEFS-SF), occupational balance (Occupational Balance Questionnaire - OBQ11), and quality of life (World Health Organization Quality of Life-BREF - WHOQOL-BREF). Socio-demographic and clinical characteristics were collected to characterize the study sample and inform interpretation of the findings. Mediation analyses were conducted to examine executive functioning as a mechanism linking disease burden to functional outcomes, using Hayes' PROCESS. Results: Compared with healthy controls, women with endometriosis reported significantly greater pain severity, pain catastrophizing, emotional distress, and executive functioning difficulties, alongside lower occupational balance and reduced quality of life (all p <0.001). Within the endometriosis group, higher levels of pain catastrophizing and emotional distress were associated with poorer executive functioning, which in turn was associated with lower occupational balance and quality of life (all p <0.001). Mediation analyses indicated that executive functioning fully mediated the associations between psychological disease burden and both quality of life and occupational balance, such that the direct associations between psychological disease burden and functional outcomes were no longer significant after accounting for executive functioning. Conclusion: Executive functioning represents a central mechanism through which pain-related and psychological disease burden translate into disruptions in daily life among women with endometriosis. These findings extend symptom-based models toward a more integrative, function-oriented understanding of endometriosis and highlight executive functioning as a meaningful target for comprehensive, person-centered assessment and intervention.

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Outcome instruments

VAS-pain

Condition tags

endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (65)

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