A systematic review and meta-analysis of the Endometriosis and Mental-Health Sequelae; The ELEMI Project

Abstract

Background: It is important to evaluate sequalae for complex chronic health conditions such as endometriosis and mental health disorders. Endometriosis impacts 1 in 10 women. Mental health outcomes can be a primary determinant in many physical health conditions although this is an area not well researched particularly in women’s health. This has been problematic for endometriosis patients in particular, who report mental health issues as well as other key comorbidities such as chronic pelvic pain and infertility. This could be partly due to the complexities associated with comprehensively exploring overlaps between physical and mental health disorders in the presence of multiple comorbidities and their potential mechanistic relationship. Methods: In this evidence synthesis, a systematic methodology and mixed-methods approaches were used to synthesize both qualitative and quantitative data to examine the prevalence of the overlapping sequalae between endometriosis and psychiatric symptoms and disorders. As part of this, an evidence synthesis protocol was developed which included a systematic review protocol that was published on PROSPERO (CRD42020181495). The aim was to identify and evaluate mental health reported outcomes and prevalence of symptoms and psychiatric disorders associated with endometriosis. Findings: A total of 34 papers were included in the systematic review and 15 were included in the meta-analysis. Anxiety and depression symptoms were the most commonly reported mental health outcomes while a pooled analysis also revealed high prevalence of chronic pelvic pain and dyspareunia. Interpretation: It is evident that small-scale cross-sectional studies have been conducted in a variety of settings to determine mental health outcomes among endometriosis patients. Further research is required to comprehensively evaluate the mental health sequalae with endometriosis.

Anhedonia in endometriosis: An unexplored symptom

“…Beyond its physical symptoms and body systemic impact, endometriosis presents a substantial comorbidity with mental health symptoms and disorders (Laganà et al, 2015(Laganà et al, , 2017a. Currently, depression and anxiety have been the psychological outcomes most often discussed in the endometriosis literature (Delanerolle et al, 2021). Studies consistently report a higher prevalence of depression in women with endometriosis as compared with other groups.…”

“…As has been reported in a recent meta-analysis, this effect increases significantly when the comparison comprises exclusively well-matched, healthy controls (Gambadauro et al, 2019). Interestingly, in 2021, another systematic review and meta-analysis reported a prevalence of 28.9% for depression and 31.8% for anxiety (Delanerolle et al, 2021).…”

Correlates of Sexual Function in a Sample of Spanish Women with Endometriosis

“…Between 1 January 2021 and 30 June 2021, a multicentre cross-sectional study was performed to assess sexual function in a sample of Spanish women diagnosed with endometriosis, using the validated Female Sexual Function Inventory (FSFI) [ 30 , 31 ]. The diagnosis of endometriosis was made in accordance with the guidelines of the European Society of Human Reproduction and Embryology (ESHRE), based on the visual detection of endometriosic lesions during previous surgeries, anatomopathological tests, and typical ultrasonographic features of endometriosis [ 32 ].…”

“…Despite dyspareunia, as well know, plays an important role as an etiologic factor of sexual dysfunction [ 24 , 25 ], which is source of low self-esteem and negative effects on interpersonal relationships [ 22 ], there are other factors not necessarily related to severity of the disease or level of tissue invasion (that include women’s age, mental health, or social or cultural correlates) have been also reported [ 26 , 27 , 28 , 29 , 30 ]. Women with endometriosis report more depression and anxiety symptoms [ 31 ], which might in turn impact sexual function.…”

Internet-based cognitive behavioral therapy for improving health-related quality of life in patients with endometriosis: study protocol for a randomized controlled trial

“…Chronic inflammation contributes to enhanced sensibility of nociceptive afferents [ 27 ], supporting peripheral and central sensitization processes [ 28 ] in regard to chronic pelvic pain (CPP) as one of the cardinal symptoms [ 1 ]. Overall, the complex pathogenesis might contribute to the existing knowledge gap regarding the precise mental health sequelae of endometriosis and unsubstantiated presumptions about the causality between physical and psychological symptoms [ 29 ].…”