Endometriosis alters women’s self-behavior

Endometriosis is known to cause depression but what about a tendency to violence?

Key Points

Highlights:

• Endometriosis-related pain and the presence of painful chronic diseases other than endometriosis significantly increased depression, anxiety, and self-directed violence in women with endometriosis.

Importance:

• It is important to evaluate the relationship between depression, anxiety, and suicide attempts in women with endometriosis.

What's done here:

• This retrospective study was conducted using the Clinformatics® Data Mart (Optum, Inc. Eden Prairie, Minnesota)database that includes almost 87.4 million individuals.
• International Classification of Disease codes for endometriosis was used for patient’ anamnesis and laparoscopic confirmation.
• The patients with known history of depression, anxiety, suicide attempt, and currently using anti-depressant or anti-anxiety pills were excluded.
• Up to two age-matched female patients constituted the control group.

Key Results:

• A total of 72,677 women with endometriosis were compared to 147,251 women without endometriosis (controls).
• The white and non-Hispanic proportion was higher in women with endometriosis, and dysmenorrhea, dyspareunia, pelvic pain, and infertility symptoms were common in endometriosis group.
• Additionally, pain-related comorbidities, immunological and chronic conditions, opioid and non-opioid drug use were significantly higher in women with endometriosis.
• Furthermore, women diagnosed with endometriosis had a significantly higher rate of anxiety, depression, and self-directed violence.
• Statistical analysis revealed that anxiety was 1.4 times, depression was 1.48 times, and self-directed violence was 2 times higher in women with endometriosis.
• Endometriosis-related pain was the risk factor with higher anxiety, depression, and self-directed harm.

Limitations:

• The retrospective nature of the study, not focusing on financial aspects of endometriosis-related problems and  not evaluating the period between endometriosis and endometriosis-related behavior change may be the main limitations.

Lay Summary

Endometriosis diagnosis is given to almost 15% of women of reproductive age. Although endometriosis could be asymptomatic, many women with endometriosis are faced with several symptoms including chronic pelvic pain, dysmenorrhea, dyspareunia, dyschezia, dysuria, and infertility.

The wide variability of symptoms resulting in delayed diagnosis and optimal treatment deteriorate patients’ quality of life.

To investigate the effect of endometriosis on womens’ behavior, Estes and colleagues, reviewed the database of Clinformatics® Data Mart (Optum, Inc. Eden Prairie, Minnesota) which includes almost 87.4 million individuals of United Healthcare between May 1, 2000, and March 31, 2019,.

The authors compared patients with and without endometriosis in same age group, age-matched controls being twice in number, to yield higher precision.

The authors concluded that patients with endometriosis had a significantly higher rate of anxiety, depression, and self-reported harm. Also, pain-related comorbidities, immunological and chronic conditions, opioid and non-opioid drug used were significantly higher in women with endometriosis. The endometriosis-related pain including dysmenorrhea, dyspareunia, and pelvic pain was the risk factor for higher anxiety, depression, and self-directed harm.

The authors concluded that clinicians' main aim should be to stop the pain and define the burdens that pain caused on women and manage the patients with a multidisciplinary approach.

Research Source: https://pubmed.ncbi.nlm.nih.gov/33184648/