Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries

• Published in: Fertility and sterility Vol. 96; no. 2; pp. 366 - 373.e8
• Main Authors: Nnoaham, Kelechi E., M.D, Hummelshoj, Lone, Webster, Premila, M.D, d’Hooghe, Thomas, M.D, de Cicco Nardone, Fiorenzo, M.D, de Cicco Nardone, Carlo, M.D, Jenkinson, Crispin, D.Phil, Kennedy, Stephen H., M.R.C.O.G, Zondervan, Krina T., D.Phil
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2011; Elsevier
• Subjects: Adolescent; Adult; Biological and medical sciences; body mass index; Chi-Square Distribution; China; Cost of Illness; Cross-Sectional Studies; Delayed Diagnosis; Efficiency; Employment - economics; Endometriosis; Endometriosis - complications; Endometriosis - diagnosis; Endometriosis - economics; Endometriosis - psychology; Endometriosis - therapy; Europe; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; health services; Humans; Internal Medicine; laparoscopy; Linear Models; Logistic Models; Medical sciences; Middle Aged; Nigeria; Non tumoral diseases; Obstetrics and Gynecology; pain; patients; premenopause; Primary Health Care; Prognosis; Prospective Studies; Quality of Life; recruitment; South America; Surveys and Questionnaires; Time Factors; United States; women; work productivity; Young Adult; Nigeria; Italy; South America; United States; China; Europe; work productivity; quality of life; Endometriosis; Multicenter study; Gynecology; Uterine diseases; Obstetrics; Female genital diseases; Quality of life
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2011.05.090

Objective To assess the impact of endometriosis on health-related quality of life (HRQoL) and work productivity. Design Multicenter cross-sectional study with prospective recruitment. Setting Sixteen clinical centers in ten countries. Patient(s) A total of 1,418 premenopausal women, aged 18–45 years, without a previous surgical diagnosis of endometriosis, having laparoscopy to investigate symptoms or to be sterilized. Intervention(s) None. Main Outcome Measure(s) Diagnostic delay, HRQoL, and work productivity. Result(s) There was a delay of 6.7 years, principally in primary care, between onset of symptoms and a surgical diagnosis of endometriosis, which was longer in centers where women received predominantly state-funded health care (8.3 vs. 5.5 years). Delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia, and heavy periods) and a higher body mass index. Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis. Each affected woman lost on average 10.8 hours (SD 12.2) of work weekly, mainly owing to reduced effectiveness while working. Loss of work productivity translated into significant costs per woman/week, from US$4 in Nigeria to US$456 in Italy. Conclusion(s) Endometriosis impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity.