Severe Dysmenorrhea Is the Primary Contributor to Low Physical Quality of Life in Canadian Women with Endometriosis

Abstract

Study Objective (1) To compare quality of life (QoL) in women presenting for endometriosis care at a Canadian tertiary care centre to the general population and (2) to identify significant factors associated with reduced physical and mental QoL. Design Prospective observational questionnaire study. Setting Tertiary academic hospital. Patients or Participants Women with clinically suspected or surgically confirmed endometriosis. Interventions Participants were recruited at the time of consultation and completed the Medical Outcome Survey (SF-36) and the Endometriosis Phenome and Biobanking Harmonization Project Minimum Clinical Questionnaire prior to treatment. SF-36 scores were compared to the Canadian normative data for women aged 35-44 years. Logistic regressions (controlled for co-morbidities) were performed for patient reported demographics, endometriosis related symptomology, endometriosis type, treatment history and diagnostic delay with high and low physical (PCS) and mental (MCS) component summary scores as the outcome. Significant factors (p Measurements and Main Results Ninety participants completed the questionnaires. Sixty-two (69%) patients presented with deep, 8 (9%) with ovarian, and 18 (20%) with superficial endometriosis. Two (2%) participants were excluded after surgical confirmation of no endometriosis. Endometriosis participants scored significantly less in all SF-36 subdomains than the Canadian women normative data (mean% difference=16-47%). Significant factors associated with the low PCS scores were age dysmenorrhea began (OR=0.92, 95%CI=0.85-0.99), severe dysmenorrhea (OR=4.85, 95%CI=1.58-14.89), dyspareunia (OR=10.26, 95%CI=1.26-86.47), dysuria (OR=4.39, 95%CI=1.47-13.01), non-cyclic pelvic pain (OR=4.05, 95%CI=1.36-12.06), and number of endometriosis symptoms (OR=2.02, 95%CI=1.29-3.18). In the final model, only severe dysmenorrhea remained significantly associated with low PCS score (OR=5.27, 95%CI=1.06-33.73). No factors were significantly associated with MCS scores. Conclusion Endometriosis negatively impacts women's QoL with scores up to 47% less than the general population. Severe dysmenorrhea was the primary contributor to poor physical quality of life, highlighting the importance of treating endometriosis-associated menstrual pain as a primary outcome in this patient population.