Psychological Stress in Endometriosis

Numerous studies highlight that endometriosis induces physical symptoms and imposes a significant psychological toll on those living with the condition. As a result, the quality of life of the affected individuals is often diminished, and their stress levels are heightened [3, 4, 9, 10, 17]. It is crucial to emphasize that endometriosis is not a psychosomatic ailment and does not stem from psychological issues. Instead, it signifies that women grappling with endometriosis must confront more challenges in their daily lives than their healthy counterparts. These challenges are not imagined but very tangible, impacting various facets of life. Regrettably, they can also exacerbate certain mental health conditions, leading to a higher prevalence than healthy women. Given this, it becomes even more imperative for the healthcare system to address these stressors proactively.

Symptom Burden

The initial burden of endometriosis often stems from the prolonged uncertainty until diagnosis. Research indicates that the average time from symptom onset to diagnosis ranges between 5 and 9 years [3]. Longer diagnostic delays are associated with a notable decline in quality of life.

Several factors contribute to this situation. The prevalence of chronic pain significantly curtails the quality of life for women grappling with endometriosis  [3,4]. Beyond pain, endometriosis introduces a host of additional symptoms that complicate everyday life. For instance, fatigue, which afflicts approximately 50-70% of women with endometriosis, is often severe and profoundly restrictive. Moreover, nearly half of those affected report experiencing sleep disturbances [8]. These sleep disruptions, in turn, exacerbate the erosion of both quality of life and energy levels.

Endometriosis-associated symptoms, including abdominal pain and discomfort during sexual intercourse, can markedly impact the sexuality of affected individuals. Studies have unveiled a decrease in the frequency of sexual activity, mainly linked to the severity of pain experienced. The intricate interplay of pain often leads to diminished sexual satisfaction [18,21]. This sexual struggle subsequently ripples into the realm of partnership, tarnishing the quality of life [5,13]. Notably, a survey involving 931 women revealed that 50% believed their relationships were affected by endometriosis [4]. Elements such as pain during intercourse [7], reduced sexual interest, bleeding during intimacy, fertility challenges, mood fluctuations, and fatigue contribute to this dynamic [5]. Moreover, it is not solely the affected women who feel the impact; their partners are also significantly influenced by the condition [13].

Wärmflasche

Causes – Stress Due to Effects of the Condition

The impact of the condition can extend to various aspects of the social environment [5, 15]. Approximately 19% to 48% of those affected report limitations in their social life and social activities [3,8]. Darüber hinaus nehmen Betroffene eine Stigmatisierung der Erkrankung wahr, und scheuen deshalb davor zurück in ihrem Umfeld über ihre Erkrankung zu sprechen [16].

Likewise, self-esteem and body image might be influenced among individuals with endometriosis [6,11]. However, there is limited research available on this subject.

Furthermore, the condition can have implications for performance and work life. In one study, about half of the participants indicated that endometriosis impacted their work-life [4]. Another study involving 810 individuals with endometriosis reported decreased productivity [19]. On average, they experienced a loss of 1.1 hours per week due to absenteeism and 5.3 hours due to reduced work performance. Similarly, they missed 2.5 hours in their personal lives due to reduced performance. In another study, those with endometriosis lost an average of 10.8 hours of productive time per week for health-related reasons, significantly more time than healthy women. The severity of endometriosis and its symptoms correlated with a higher reduction in productivity [12]. Consequently, endometriosis can impose a notable financial burden as well.

Frequency of Psychological Impact

Given the many stresses that endometriosis can impose, it is unsurprising that it is linked to a heightened risk of mental health disorders such as depression and anxiety. Despite this well-established connection, the precise prevalence of mental health symptoms among individuals with endometriosis remains unclear due to inconsistent findings in existing studies [1, 2, 17].

Pain appears to be a significant contributing factor in this context. For instance, one study discovered that depression affected 38% of women without chronic lower abdominal pain, while the figure rose to 86% among those experiencing chronic lower abdominal pain [9]. In another survey involving 104 women with endometriosis, approximately 86.5% exhibited varying degrees of depressive symptoms, and 87.5% displayed different degrees of anxiety. The severity of pain correlated with the intensity of anxiety symptoms, although no link was established between the stage of endometriosis and mental health [17].

Müde Frau

The Interplay Between Pain and Mental Well-Being

The intensity of pain appears to play a pivotal role in this context. This aligns with the findings from a survey involving 57 endometriosis patients, wherein chronic lower abdominal pain was once again linked to diminished quality of life and heightened psychological challenges. Interestingly, beyond the influence of pain, endometriosis no longer exhibited an additional impact on the quality of life [20]. When women experiencing chronic pain from endometriosis were compared with those facing chronic abdominal pain due to other conditions, no discrepancies were observed regarding depressive symptoms and emotional distress [14].

Taken together, women with endometriosis and its associated pain seem to report elevated anxiety and depressive symptoms compared to healthy women or those without pain.

While more research is necessary in this domain, existing studies already indicate a cyclic pattern wherein psychological issues, daily stressors, and pain coalesce to intensify one another in individuals with endometriosis patients [5,9,17]. While psychological discomfort does not cause endometriosis, this symbiotic relationship can exacerbate preexisting pain and issues like relationship conflicts.

In a Nutshell

To summarize, endometriosis profoundly impacts various facets of individuals’ lives, encompassing work, leisure, sexuality, relationships, self-esteem, and mental well-being. Notably, pain amplifies social and psychological stress in a self-perpetuating cycle. Thus, a multidisciplinary approach becomes imperative – one that addresses the medical dimensions and extends comprehensive support to those affected. This entails a spectrum of interventions, including exercise therapy, nutritional guidance, physical therapy, psychological treatments, meditation, and relaxation practices, to name a few. Nonetheless, further investigation is warranted to ensure optimal treatment in the future.

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