Endometriosis is associated with a number of symptoms, such as infertility, painful sexual intercourse and chronic pelvic pain. Their impact on the mental health and social life of women with endometriosis is often significant (1,2). This is understandable if one considers the negative effect of chronic pain in the social and professional life of patients in general.

  Pope et al. demonstrated that endometriosis is associated with a number of mental health conditions, such as depression, anxiety and stress disorders(3). However, the actual incidence of those conditions in women with endometriosis differs from study to study. According to Sepulcri and Do Amaral’s study(4), almost 9 in 10 women with endometriosis suffered from depression or stress disorders, in contrast with Friedl et al(5), whereby less than 1/3 of patients had either. The stage of the disease does not appear to correlate with the likelihood of presenting with mental health problems, however, advancing age of the patient appears to increase the likelihood of depression(4). Moreover, the presence of depression itself appears to worsen the perception of chronic pain in women with endometriosis. Since our understanding of the pathophysiology of chronic pain is not complete, the co-existence of chronic pain and depression can make it difficult to differentiate which is the cause and which the consequence.

   As mentioned previously, endometriosis is a common cause of infertility and infertility itself can have a negative impact on the emotional well-being of patients. In a study by Berqvist and Theorell(6), comparing the mental health of women with endometriosis-associated infertility and endometriosis without infertility, the first group of women seeked psychological support (or expressed the wish to) in 50% of cases.

  The successful management of endometriosis( medical or surgical) can reverse the negative impact of the disease in the mental health and overall quality of life of patients(2). However, long-term medical management appears to have a negative impact, overall, in the quality of life of those women(4). The study by Garry et al.(7), bears particular interest, as it examines the role of excisional surgery for endometriosis: the authors demonstrated that it is associated with a significant improvement in the overall quality of life of women with endometriosis.

 In conclusion, it is recommended that a thorough assessment of the emotional profile and overall quality of life takes place in the beginning as well during the management of patients with endometriosis, as it can serve as another measure of the success of the management option used. The successful management of endometriosis and its associated symptoms by a team of healthcare professionals with the relevant training and expertise is associated with an improvement in the mental health status and quality of life of patients with endometriosis.

References:

1. Friedl F, Riedl D, Fessler S, et al. Impact of endometriosis on quality of life, anxiety, and depression: an Austrian perspective. Arch Gynecol Obstet. 2015;292(6):1393–1399.
2. Jia SZ, Leng JH, Shi JH, Sun PR, Lang JH. Health-related quality of life in women with endometriosis: a systematic review. J Ovarian Res. 2012;5(1):29.
3. Pope CJ, Sharma V, Sharma S, Mazmanian D. A systematic review of the association between psychiatric disturbances and endometriosis. J Obstet Gynaecol Can. 2015;37(11):1006–1015.
4. Sepulcri Rde P, do Amaral VF. Depressive symptoms, anxiety, and quality of life in women with pelvic endometriosis. Eur J Obstet Gynecol Reprod Biol. 2009;142(1):53–56.
5. Friedl F, Riedl D, Fessler S, et al. Impact of endometriosis on quality of life, anxiety, and depression: an Austrian perspective. Arch Gynecol Obstet. 2015;292(6):1393–1399.
6. Bergqvist A, Theorell T. Changes in quality of life after hormonal treatment of endometriosis. Acta Obstet Gynecol Scand 2001;80:628–37.
7. ] Garry R, Clayton R, Hawe J. The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. Br J Obstet Gynecol 2000;107: 44–5.