Changes in quality of life (QOL) in women with symptomatic endometriosis by pain type during treatment

Abstract

OBJECTIVE: To assess the improvement in quality of life of women with symptomatic endometriosis (endo) after 24 weeks of treatment. DESIGN: Prospective. MATERIALS AND METHODS: 55 women with symptomatic endo were randomized in a double-masked study of Leuprolide 11.25mg vs. Norethindrone Acetate 5mg. QOL was determined using a modified version of Kennedy's QOL questionnaire: visual analog scale (VAS) was used to assess menstrual, coital and non-menstrual pain. Women were categorized by the duration of pain in a month: persistent pain (>7 days, PP; n=27) vs occasional pain (>7 days, OP; n=28). Cumulative QOL scores were evaluated to assess improvement during treatment. Data were analyzed using paired and two-sample t-tests and their non-parametric correlates, and Kruskal-Wallis tests. RESULTS: Women were predominantly Black (75%), aged between 21 and 50 years, who experienced pelvic pain for an average 14.7 ± 7.9 years. PP women reported having more severe menstrual pain (8.4 ± 1.4 vs 6.8 ± 2.1; p=0.0029) and non-menstrual pain (7.4 ± 1.6 vs 3.1 ± 2.8; p<0.0001) than OP women. Menstrual and non-menstrual pain improved over time (p<0.0001; p<0.0001, respectively). PP women had improvements in menstrual (p<0.0001) and non-menstrual pain (p<0.0001), and OP only had improvement in menstrual pain (p=0.0017). No differences were observed for coital pain. While there were statistically significant improvements in QOL scores over time for each group (PP p=0.0016 and OP p=0.0017), there were no differences observed between groups. 29 (74.4%) of the women had improved QOL scores, with 13 (33.3%) having improvement of ≥30% from entry, which were similar between groups. CONCLUSION: QOL and VAS significantly improved with treatment. PP women reported having more relief in menstrual and non-menstrual pain than OP women. This may be due to PP women being more sensitive to pain and thus perceiving any relief in pain more positively than OP women who experience pain less frequently.