Why does endometriosis appear?

 The causes and mechanisms of how endometriosis occurs are not clear, although heredity plays a role, as well as immunological and environmental factors.

 We differentiate between superficial endometriosis, ovarian endometriomas, or deep endometriosis that can affect the utero sacral ligaments, vagina, intestinal wall, rectum vaginal septum, ureters or bladder. Diagnosis is often delayed and it can take several years before these women are diagnosed and treated, which can severely affect their quality of life.

How does endometriosis affect the daily lives of women with endometriosis?

There is clear evidence of the impact of this disease on the quality of life of women who suffer from it, mainly due to the pain clinic.  Pain can affect sleep quality, accentuate stress, decrease activity levels, as well as produce other psychological disorders such as anxiety. Symptoms such as fatigue, heavy bleeding, mood swings, lead to absenteeism from work or inability to work long hours, which makes them feel guilty.  Pain with sexual relations also affects their relationship with their partner. Their interpersonal relationships suffer and they often become socially isolated.

 The concept of quality of life encompasses physical, psychological and social aspects. Various instruments have been used to assess this concept and it has been found that women with endometriosis have lower levels of quality of life scores than the general population, especially in terms of vitality, physical fitness, and general health (1).

Does endometriosis affect sexuality?

In relation to their sexuality, the symptoms related to endometriosis (dyspareunia – pain during sexual intercourse -, chronic pelvic pain, psychological factors, especially depression) reduce the number and quality of sexual relations, generally compromising their sexual activity, self-esteem and degree of satisfaction (2).

 Endometriosis may be associated with profound dyspareunia in relation to central sensitisation, or the presence of deep endometriosis. In patients with dyspareunia, those with deep endometriosis and involvement of the utero-sacral ligaments have been found to have a higher level of pain, less satisfactory orgasm, and fewer sexual relations.

 In addition, their psychological state may also affect the sexual sphere; a depressive state is associated with less sexual desire, less arousal, sexual fantasies or orgasm. In short, they have fewer and less satisfying sexual relations. The improvement either by surgery or medical treatment of your deep endometriosis will contribute to improving your sexual sphere.

Impact on interpersonal relationships

 In terms of their interpersonal relationships, most women with endometriosis perceive a lack of support and understanding in their environment (3). They feel embarrassed and unable to share their health problems with their family, employer and friends. The impact on their quality of life is often not appreciated by the clinician, which deteriorates the doctor-patient relationship. However, the greatest impact is on their relationship with their partner, not only because of dyspareunia but also because of weakness, taking various drugs, bleeding, and problems conceiving.

Endometriosis, depression and anxiety

Endometriosis can also have psychological effects, and Caviggioni (4) has published a higher prevalence of depression, anxiety disorders, and emotional distress in these women than in the general population.  Both anxiety and depression increase the perception of pain, and pain also compromises the emotional sphere, thus completing a vicious circle. On the other hand, the quality of sleep deteriorates, which also exacerbates the perception of pain. There is a clear association between sleep quality and depression; sleep deficit worsens mood, favouring depression, and depression promotes sleep deficit. Several authors have seen that the improvement in pain symptoms in these women has a clear positive impact on their psychological sphere (5). 

 In short, endometriosis is a pathology that affects all aspects of a woman’s life and must be treated by a multidisciplinary team that includes not only medical treatment but also psychological, occupational and social support.

 In our fertility clinic in Malaga we specialise in the diagnosis and treatment of endometriosis, and we know that the key is often to listen to the patient in order to find the diagnosis, as well as carrying out tests to confirm it.

 If you have painful periods that prevent you from facing your daily life normally, from Clínica Fertia we encourage you to ask for a free first visit so that we can know your case, the diagnosis is key to begin to control the pain and improve the quality of life in patients with endometriosis.

Bibliography

1. Lovkvist L, Bostrom P,Edlund M, Olovsson M. Age-related differences in quality of life in swedish women with endometriosis.J Womens Health.2016;25:646-653.
2. Ferrero S, Esposito F, Abbamonte LH, Anserini P,Remorgida V, Ragni N. Quality of sex life in women with endoemtriosis and Deep dispareunia.Fertil Steril.2005,5.184-195.
3. Rush G, Misajon R.Examining subjective wellbeing and health-related quality of life in women with endometriosis.Health Care Women Int.2018;39:303-321.
4. Cavaggioni G, Lia C, Resta S, Antonielli T, Benedetti P,Megiorni F, Porpora MG. Are mood and anxiety disorders and alexithymia associated with endometriosis?. A preliminary study.BioMed Res Int.2014.
5. Lagana AS,Condemi i, Retto G, Muscatello MR,Bruno A, Zoccali RA,Triolo O, Cedro C. Analysis of psycopathological comorbidity behind the common symptoms and signs of endometriosis.Eur J Obstet Gynecol Reprod Biol.2015;194:30-33.