Women With Endometriosis More Likely to Experience Mental Health, Menstrual, Pain Symptoms


Women with endometriosis face an average of 7 to 11 years between the time of symptom onset and diagnosis, during which they experience increased symptoms, hospitalizations, and health care resource utilization.

Mental health, menstrual, and other pain symptoms are more common in women with endometriosis, according to a recent study published in the American Journal of Obstetrics & Gynecology.1

Endometriosis, characterized by endometrium-like tissue outside the uterus, is reported in 11.4% of women in Australia by the age of 44 years. Endometriosis increases the risk of hospitalization, as well as decreasing work productivity and quality of life.

The mean delay of time between symptom onset and diagnosis is 7 to 11 years, causing increased symptoms, hospitalizations, and health care resource utilization. Data has also indicated women with endometriosis are at increased risk of chronic pelvic pain, heavy menstrual bleeding, dyspareunia, dyschezia, dysmenorrhea, and fatigue.

Most data on endometriosis and common symptoms come from cross-sectional or descriptive studies. Investigators evaluated the association between endometriosis and common symptoms using data from the Australian Longitudinal Study on Women’s Health (ALSWH), a large, population-based prospective cohort study.

Over 40,000 women across 3 age cohorts were included in the ALSWH. Patients completed 8 consecutive surveys through postal or online questionnaires. Surveys were completed every 3 years between 1996 and 2018.

In the current analysis, patients born between 1973 and 1978 who completed symptoms checklist surveys from 2009 to 2018 were included. Self-reported surveys and administrative health records were assessed to determine endometriosis incidence.

Endometriosis was categorized as clinically suspected or surgically confirmed, with an endometriosis diagnosis recorded in Medicare Benefits Schedule (MBS) or hospital data used to define surgically confirmed endometriosis. Cases of endometriosis only confirmed by self-report or endometriosis medication prescriptions were defined as clinically suspected endometriosis.

Women’s symptoms were evaluated using data from self-reported surveys in 2009, 2012, 2015, and 2018. Women were asked if they had experienced symptoms within the previous 12 months. Response options included never, rarely, sometimes, and often.

Symptoms included allergies, headaches, severe tiredness, indigestion, difficulty breathing, stiff joints, back pain, foot problems, skin problems, premenstrual tension, palpitations, severe period pain, heavy menstrual bleeding, irregular periods, leaking urine, urine burns, vaginal irritation, hemorrhoids, constipation, and bowel problems.

Covariates included women’s age, marital status, residence, income, education, alcohol intake, smoking, physical activity, body mass index, contraceptive use, and parity.

There were 7606 women included in the final analysis, with 1149 endometriosis cases reported across this population, 565 surgically confirmed and 584 clinically suspected. Endometriosis was more common in women who were underweight, living in urban areas, and sedentary.

Symptoms overall were more common in women with endometriosis. Symptoms seen more often in women with endometriosis include mental, menstrual, urinary, bowel, and other nonspecific symptoms. These associations were seen after adjusting for covariates, but endometriosis was not associated with skin problems, leaking urine, or breathing difficulty.

Endometriosis was significantly associated with menstrual symptoms including heavy menstrual bleeding, severe period pain, premenstrual tension, and irregular period. Mental health symptoms including depression, anxiety, and other menstrual problems were also more common in women with endometriosis.

Somatic and allergic symptoms were reported more in women with endometriosis, as well as severe tiredness, back pain, allergies, headaches, stiff joints, and feet problems with odds rations of 1.79, 1.76, 1.50, 1.62, 1.65, and 1.53 respectively. The odd of palpitations increased by 77% in women with endometriosis, and sleep difficulty by 56%.

In women with endometriosis, constipation, hemorrhoids or piles, and indigestion or heartburn odds increased by 67%, 46%, and 25% respectively. Urine burn and vaginal irritation were also more common in women with endometriosis.

These associations were found in both surgically confirmed and clinically suspected endometriosis, indicating a broad range of symptoms associated with endometriosis. Investigators recommended further studies to evaluate potential biologic pathways between endometriosis and associated symptoms.

This article originally appeared in Contemporary OB/GYN.

1. Gete DG, Doust J, Mortlock S, Montgomery G, Mishra GD. Associations between endometriosis and common symptoms: findings from the Australian Longitudinal Study on Women’s Health. American Journal of Obstetrics & Gynecology. 2023;229(5):536.E1-536.E20. doi:10.1016/j.ajog.2023.07.033
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