From fertility to mental wellbeing, researchers identify the health and lifestyle factors most closely linked to the daily burden of endometriosis.

A new study published in Frontiers in Global Women’s Health

Endometriosis disrupts multiple aspects of women's lives

Endometriosis is a chronic gynecological disease characterized by the presence of endometrial-like tissue outside the uterus. The condition is associated with a number of symptoms, including chronic pelvic pain, severe menstrual cramps, painful sexual intercourse, painful defecation, and infertility.

Despite high global prevalence among women of reproductive age, endometriosis is often regarded as a “missed disease” due to its unclear etiology and frequent diagnostic delays. Because of the unavailability of completely curative treatments, women living with endometriosis often experience physical, psychological, and social distress and poor quality of life.

The current study aimed to explore multiple dimensions of quality of life and assess their associations with disease-related symptoms and lifestyle characteristics in women with endometriosis.

Researchers assessed health habits and quality of life

The study included 153 adult women with self-reported endometriosis. Self-reported information on sociodemographic characteristics, body weight change, digestive symptoms, physical activity, dietary habits, use of addictive substances, and the perceived impact of endometriosis on quality of life were collected through the Questionnaire on Health and Lifestyle Habits among Women with Endometriosis and the Endometriosis Impact Questionnaire.

The Endometriosis Impact Questionnaire was used to evaluate the long-term effect of endometriosis on eight dimensions of quality of life, including physical, psychological, and social wellbeing, sexual behaviors, fertility-related issues, financial status, educational status, and lifestyle-related coping behaviors, especially the use of alcohol, tobacco, or other illicit substances to cope with endometriosis symptoms.

Lifestyle factors shaped multiple quality-of-life outcomes

The analysis revealed that endometriosis affects multiple aspects of women's lives, with the greatest impact on fertility, followed by physical, psychological, and social wellbeing. Lifestyle-related coping behaviors were the least affected domain, and across most quality-of-life measures, women reported the greatest disease burden during the previous 12 months.

The researchers also identified several health and lifestyle factors associated with a greater impact of endometriosis on quality of life. Women who reported body weight changes after symptom onset experienced poorer outcomes across all quality-of-life dimensions, while smokers showed a greater impact on financial and lifestyle-related measures. Painful defecation was likewise associated with a higher overall disease burden.

When the researchers examined individual quality-of-life dimensions, they found that higher BMI was associated with greater physical and psychological impact, although BMI showed different patterns depending on how it was analyzed, highlighting the complexity of interpreting body weight in relation to endometriosis. Fertility-related quality of life was positively associated with following a dietary regimen and negatively associated with dietary supplement use. Smoking was also associated with greater lifestyle-related impact and poorer overall quality of life, while painful defecation was specifically linked to poorer psychological and sexual quality of life.

Opportunities for multidisciplinary disease management

The study identifies modifiable health and lifestyle factors that are associated with the overall impact of endometriosis on women's quality of life. The findings highlight the need for integrating lifestyle and psychosocial components into routine endometriosis care.

As observed in the study, endometriosis-related body weight changes significantly influence multiple dimensions of quality of life, indicating that body weight changes may represent an important indicator of disease burden. In this context, existing evidence indicates that body weight changes can affect physical and psychological wellbeing, which in turn can potentially aggravate pain perception, fatigue, depressive symptoms, and social withdrawal.

These findings suggest that structured weight management counseling, nutritional guidance, and psychological support could be incorporated into multidisciplinary care models to manage disease-related weight changes and improve overall quality of life in women with endometriosis.

The current study found an association between painful defecation due to endometriosis and poorer psychological and sexual dimensions of quality of life. These findings highlight the need for considering gastrointestinal symptoms as an important component of women's quality of life with endometriosis. Improved screening for gastrointestinal symptoms and timely referral pathways within gynecological services are therefore needed to help women improve mental health, sexual wellbeing, and overall quality of life.

The observed associations between dietary supplement use, dietary regimens, and the fertility dimension of quality of life highlight the complex interplay between reproductive concerns and self-directed health behaviors. Overall, these findings support the development of evidence-based, personalized nutritional guidance for women with endometriosis. 

Among analyzed lifestyle factors, the study found an association between smoking and greater overall disease impact on quality of life. Previous research cited by the authors suggests that smoking may exacerbate endometriosis through oxidative stress, endocrine disruption, and chronic inflammation. Smoking can also negatively affect fertility by disrupting the hypothalamic–pituitary–ovarian axis. Strategies aiming at smoking cessation are therefore needed in gynecological services for both symptom management and long-term health outcomes.

Because of the cross-sectional design and reliance on self-reported data, the study could not determine the causality of observed associations. Future longitudinal research involving clinically confirmed endometriosis cases and considering objective indicators of disease severity is needed to better understand causal pathways. Such research is particularly needed for developing clinical and public health strategies aiming at reducing disease burden and improving women’s quality of life.

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