Freelance writer for Contemporary OB/GYN
Research indicates that women with endometriosis are prone to physical, psychosocial, social, and sexual disturbances and obstetrical complications, according to a literature search of the impact of endometriosis on various aspects of reproductive health in the Journal of Obstetrics and Gynaecology.
Although endometriosis is not a life-threatening disease, the analysis concluded that it can significantly affect a patient’s reproductive health. “Endometriosis can be both physically and emotionally debilitating,” wrote the authors from Iran.
The authors searched four international databases for studies published in English on health issues in women with endometriosis from January 1995 to December 2019: PubMed, Science Direct, Scopus and Google scholar. A total of 46 full-text articles comprised the analysis.
Most of the papers were published in 2010 or later, reflecting a recent increase in research on the impact of endometriosis on reproductive health.
The majority of papers were also from high-income countries with developed healthcare systems: United Kingdom (n = 9), the United States (7), Brazil (5), Australia (3) Italy (3), Switzerland (2) and Japan.
The 40 quantitative studies consisted of 16 reviews, 12 cohort studies, 9 cross-sectional studies and 3 clinical trials. Conversely, the 6 qualitative studies used a range of quality-of-life instruments and assessments of variables such as symptoms, including pain; well-being; mental health; personality; and impact on work. The qualitative studies also relied on interviewing for data collection.
Study sample size varied considerably: from 16 to 116,430 women with endometriosis in quantitative studies and from 18 to 65 women with endometriosis in qualitative studies.
In addition, most of the participants had confirmed endometriosis through surgical diagnoses, for example; however, for others, diagnosis was self-reported and not clinically verified.
The physical impact from endometriosis pain can lead to complications, including chronic pelvic pain, dysmenorrhoea, dyspareunia, dyschezia and dysuria, which can decrease quality of life.
Likewise, the psychological health of women can be negatively impacted by infertility caused by endometriosis.
The social impact from endometriosis also can be exacerbated by absence from work, fewer social activities, and students missing school due to menstrual symptoms.
The disease, especially when linked to severe dyspareunia or chronic pelvic pain, can have negative effects on women’s sexual function as well, including sexual desire, orgasm, sexual satisfaction and frequency of intercourse. Fear of separation from partner can also lead to unwanted sex.
Many women with endometriosis suffer pain during sex and even have dyspareunia after intercourse.
Endometriosis also can significantly impair pregnancy by increasing the risk of abortion, gestational diabetes, and hypertensive disorders.
The authors said it is crucial that women be informed about endometriosis and that information be easily accessible in order to improve their reproductive health. They also noted that sexuality is an integral part of one’s personality, which is adversely affected by endometriosis.
Because gynecologists are the first referral for suffering women, it is of utmost importance that they engage in a “profound conversation” with patients about their sexuality, despite the fact that sexuality is often perceived as a “shameful topic.”
Similarly, patients should engage their partners in decision-making, communicating and understanding the nature of endometriosis and its potential impact on the partner and family.
However, more research is needed to elucidate endometriosis complications, according to the authors, specifically for obstetrical outcomes.
Namazi M, Moghadam ZB, Zareiyan A, Jafarabadi M. Impact of endometriosis on reproductive health: an integrative review. J Obstet Gynaecol. Published online March 1, 2021. doi:10.1080/01443615.2020.1862772