The coexistence deep infiltrating endometriosis and fibromyalgia

Women with deep infiltrating endometriosis have higher risk of developing fibromyalgia.

Key Points

Highlights:

• Endometriosis, especially deep infiltrating endometriosis, is associated with several chronic diseases which severely impair health-related quality of life and work productivity. 

Importance:

• Endometriosis-associated chronic diseases such as fibromyalgia should be carefully evaluated to improve the quality of life.

What’s done here?

• This observational case-control study evaluates the association of fibromyalgia and different types of endometriosis at a tertiary university teaching hospital in Barcelona (2015 to 2017).
• Women with deep infiltrating endometriosis (DIE), ovarian endometrioma and superficial endometriosis, all surgically confirmed, were included. 
• DIE was diagnosed as the penetration of endometriotic cells more than 5 mm, histologically confirmed after the laparoscopy. Ovarian endometrioma >3 cm diagnosed by transvaginal ultrasound and surgically confirmed. Superficial endometriosis was detected during treatment for benign adnexal pathology.
• Careful clinical examination, transvaginal ultrasound and magnetic resonance imaging in selected cases were used for diagnosis in all participants.
• The control group was selected from women without any disease and who underwent laparoscopy for another benign adnexal pathology and showed no signs of endometriosis.
• The severity of dysmenorrhea, dyspareunia, and chronic pelvic pain was scored with a visual analog scale (VAS) on a 10s scale from 0 (no pain) to 10 (unbearable pain). All study participants completed the London Fibromyalgia Epidemiological Study Screening Questionnaire (LFESSQ) for fibromyalgia screening, a six-item questionnaire with four items related to widespread pain and two items related to fatigue preoperatively.
• All women were also evaluated by the Medical Outcomes Study 36-Item Short Form (SF-36) for the general health-related quality of life.

Key results:

• A total of 229 women met the criteria and included in this study: 80 women in the DIE group, 76 in the non-DIE group, and 73 in the control group.
• Women in the DIE group reported significantly more severe pain symptoms than in the non-DIE group and the control group.
• Women in the DIE group had more surgery history for endometriosis when compared with the other groups.
• Women in the DIE group suffered from fibromyalgia more frequently than in the other groups based on fibromyalgia screening scores. These women also had a lower health-related quality of life according to VAS and SF-36.

Strengths and Limitations

• The strength of the study is that its design had strict inclusion and exclusion criteria and all women included in the study group had surgically confirmed endometriosis.
• Among several limitations, the small sample size, the diagnosis of fibromyalgia was not based on clinical examination, the absence of the evaluation for the intake of hormonal medication for endometriosis, not assessing smoking which could be another factor affecting results, the non-DIE group being the women with endometrioma and the majority of women (63%) in the DIE group having the surgical history for endometriosis were noted.

Lay Summary

Endometriosis is defined as the localization of endometrial glandular and stromal cells outside the uterine cavity. The main symptoms of endometriosis which are dysmenorrhea, dyspareunia, and chronic pelvic pain impair the quality of life of these women. This disease may be accompanied by some other chronic diseases such as fibromyalgia.

Coloma et al, a group of scientists from Spain, published a study titled as “Prevalence of fibromyalgia among women with deep infiltrating endometriosis” in the journal named as International Journal of Gynecology and Obstetrics.

The authors aimed to evaluate the association between different types of endometriosis and fibromyalgia. They also evaluated the quality of life of these women using VAS and SF-36 scores.

Women operated for deep infiltrating endometriosis had a higher risk of developing fibromyalgia based on the score named LFESSQ (London Fibromyalgia Epidemiological Study Screening Questionnaire) which is used for fibromyalgia screening. Women in the DIE group reported significantly more severe pain symptoms than in the non-DIE group and the control group. Women in the DIE group also reported significantly more severe pain symptoms than in the non-DIE group and the control group. 

“Further studies are needed to confirm whether women with DIE have an increased risk of fibromyalgia,” the authors added.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/30973964