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

Kelechi E Nnoaham; Lone Hummelshoj; Premila Webster; Thomas D'Hooghe; Fiorenzo de Cicco Nardone; Carlo de Cicco Nardone; Crispin Jenkinson; Stephen H Kennedy; Krina T Zondervan; World Endometriosis Research Foundation Global Study of Women's Health consortium

doi:10.1016/j.fertnstert.2011.05.090

Endometriosis · Diagnosis

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

Nnoaham KE, Hummelshoj L, Webster P, D'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, Jenkinson C, Kennedy SH, Zondervan KT, World Endometriosis Research Foundation Global Study of Women's Health consortium

Published August 2011 Fertility and Sterility, 96(2), 366-373.e8

DOI 10.1016/j.fertnstert.2011.05.090 PMID 21718982 PMC PMC3679489

RRM Academy Synopsis

Endometriosis is linked to lost work hours and lower quality of life

Employed women with endometriosis lost more weekly work time than symptomatic women without it. The 1,418 women in this cross-sectional study were booked for keyhole surgery at 16 hospitals in 10 countries. The average time to an endometriosis diagnosis was 6.7 years in this sample.

Key Findings

Surgeons found endometriosis in 745 of 1,418 women (52.5%, 95% CI 49.9%–55.1%). Rates were 54.3% (699/1,287) in women operated on for symptoms and 35.1% (46/131) in women having sterilization.
Time to diagnosis averaged 6.7 years (SD 6.3) with endometriosis and 5.9 years (SD 6.0) in symptomatic controls (P=.017). The women reported an average of seven visits before specialist referral.
Adjusted time to diagnosis was 8.3 years (95% CI 7.5–9.0) at centers with mostly state-funded care and 5.5 years (95% CI 5.1–5.9) at centers paid for by patients or insurers (P=.001).
Employed women with endometriosis lost 10.8 h/wk (SD 12.2) of overall work productivity, against 8.4 h/wk (SD 10.2) for symptomatic controls (P<.001).
After adjustment, affected women scored lower than symptomatic controls on physical functioning (P=.02), physical role limitation (P=.013), mental role limitation (P=.022) and bodily pain (P=.039).

Interpretation

Women answered questionnaires once, in the week before surgery. This cross-sectional design shows association and cannot show that endometriosis caused the differences. Participants were women at a first keyhole surgery for pelvic pain, trouble getting pregnant or sterilization. The authors say the findings may not reflect women who have had the condition longer. Surgeons diagnosed endometriosis by sight, without tissue tests, and women reported their own work loss. One comparison group had similar symptoms without endometriosis, and another was women having sterilization.

RRM Context

Restorative reproductive medicine starts by finding the root cause. Here, the wait for a diagnosis averaged 6.7 years in women with endometriosis. The authors attribute the wait mainly to delayed referral from primary care to a gynecologist. They call for research on pain mechanisms and symptom control.

Our editorial summary of this paper, not the article's abstract.

Abstract

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.

Patients

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.

Interventions

None.

Main Outcome Measures

Diagnostic delay, HRQoL, and work productivity.

Results

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.

Conclusions

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.

Topics

Endometriosis › Diagnosis › Diagnostic Delay · General Gynecology › Pelvic Pain › Chronic Pelvic Pain

Kelechi E Nnoaham, Lone Hummelshoj, Premila Webster, Thomas D'Hooghe, Fiorenzo de Cicco Nardone, Carlo de Cicco Nardone, Crispin Jenkinson, Stephen H Kennedy, Krina T Zondervan

K Nnoaham, L Hummelshoj, P Webster, Tom D'Hooghe, T D'Hooghe, F Nardone, C Nardone, C Jenkinson, Steve Kennedy, S Kennedy, K Zondervan

PMID 21718982 21718982 DOI 10.1016/j.fertnstert.2011.05.090 10.1016/j.fertnstert.2011.05.090 Nnoaham et al. 2011, Nnoaham 2011

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

Endometriosis is linked to lost work hours and lower quality of life

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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