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Cited by 262Endometriosis Research and TreatmentHealth Systems, Economic Evaluations, Quality of LifeMusculoskeletal pain and rehabilitation

The DOI matches its Crossref record; 48 of the 52 references it cites were found in a registry or an index; none of the 41 sources its claims cite is checked for support yet.

Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity

Open access
Fourquet, Jessica, Báez, Lorna, Figueroa, Michelle, Iriarte, R. Iván, Flores, Idhaliz·2011·Fertility and Sterility
DOI 10.1016/j.fertnstert.2011.04.095PMC PMC3129383
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Abstract

OBJECTIVE To quantify the impact of endometriosis-related symptoms on physical and mental health status, health-related quality of life (HRQoL), and work-related aspects (absenteeism, presenteeism, work productivity, activity impairment). DESIGN Cross-sectional quantitative study. SETTING Academic and research institution. PATIENT(S) Women (n=193) with self-reported surgically diagnosed endometriosis from the Endometriosis Patient Registry at Ponce School of Medicine and Health Sciences (PSMHS). INTERVENTION(S) Patients completed an anonymous questionnaire divided into three sections consisting of questions from the Patient Health Survey (SF-12®), the Endometriosis Health Profile (EHP-5), and the Work Productivity and Activity Impairment Survey (WPAI). MAIN OUTCOME MEASURE(S) Impact of endometriosis symptoms on physical and mental health status, health-related quality of life (HRQoL), absenteeism, presenteeism, work productivity and activity impairment was quantified. RESULTS Patients had SF-12 scores denoting significant disability in the phyisical and mental health components. They also reported an average of 7.41 hrs (approximately one working day) of work time loss during the week the symptoms are worse. In addition, WPAI scores show high impact on work-related domains: 13% of average loss in work time (absenteeism), 65% of their work was impaired (presenteeism), 64% loss in efficiency levels (work productivity loss), and 60% of daily activities perturbed (activity impairment). CONCLUSION Endometriosis symptoms such as chronic, incapacitating pelvic pain and infertility negatively and substantially impact the physical and mental health status, HRQoL, and productivity at work of patients with endometriosis.

Overview

Integrity signals

Registry

Crossref · 10.1016/j.fertnstert.2011.04.095

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 41 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Many women reported major distress from feeling depressed about possible infertility.

    “Also, feeling depressed due to the possibility of not being able to conceive was commonly reported as a major distress.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The Spanish version of EHP-5 used in this study was valid for measuring endometriosis-related HRQoL despite not having been formally translated and validated in Spanish.
  • Findingown data

    The EHP-5 findings showed that endometriosis symptoms adversely affect numerous areas of physical and mental health, such as sexual relationships, treatment expectations, and maternity concerns.

    “EHP-5 results further demonstrated that endometriosis symptoms negatively affect many aspects of a substantial proportion of patients’ physical and mental health, including sexual relations, treatment expectations, and maternity issues.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Spanish version of EHP-5 used in this study was valid for measuring endometriosis-related HRQoL despite not having been formally translated and validated in Spanish.
  • Findingown data

    For the 101 women who missed work because of endometriosis, the average lost work time in the past week was 7.41 hours (SD 8.97) during the week when symptoms were worst.

    “101 participants reported missing work in the past week due to their health problem (mean loss in work time = 7.41 hrs; SD±8.97 hrs) during those seven days when symptoms were worse.”
    • Also stated in: § RESULTS · plain
      “They also reported an average of 7.41 hrs (approximately one working day) of work time loss during the week the symptoms are worse.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported surgically diagnosed endometriosis in the registry accurately identifies women who have endometriosis.
    • Rests on an assumption: The WPAI instrument is valid for measuring endometriosis-related work productivity in this population.
    • Rests on an assumption: The week of the last menstrual period or when symptoms were worse is representative of the typical impact of endometriosis symptoms on work and daily activities.
    • Rests on an assumption: The 40% response rate did not introduce non-response bias that would alter the findings.
  • Premisecitation

    The WPAI is a validated tool for assessing how general and specific symptoms affect work productivity and daily tasks.

    “The Work Productivity and Activity Impairment Questionnaire (WPAI) is a validated instrument that measures the effect of both general and specific symptoms on work productivity and daily tasks (34).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Reilly, 2004, The validity and accuracy of the Work Productivity and Activity Impairment questionnaire—irritable bowel syndrome version (WPAI: IBS), Aliment Pharmacol Ther source
  • Premisecitation

    EHP-30 and its abbreviated form EHP-5 are the sole validated instruments specific to endometriosis for measuring HRQoL.

    “To date, the only validated endometriosis-specific HRQoL instruments are EHP-30 and its shorter version, EHP-5 (25-29).”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [25] Jenkinson, 2008, Evaluation of the American version of the 30-item Endometriosis Health Profile (EHP-30), Qual Life Res source
    • cites [26] Jones, 2004, Evaluating the responsiveness of the Endometriosis Health Profile Questionnaire: the EHP-30, Qual Life Res source
    • cites [27] Jones, 2001, Development of an endometriosis quality-of-life instrument: the Endometriosis Health Profile-30, Obstet Gynecol
    • cites [28] Khong, 2010, Is the 30-item Endometriosis Health Profile (EHP-30) suitable as a self-report health status instrument for clinical trials?, Fertil Steril source
    • cites [29] Jones, 2004, Development of the Short Form Endometriosis Health Profile Questionnaire: the EHP-5, Qual Life Res source
  • It may state two separate claims as one. 12
  • The quote only partly states this claim. 1
  • Probably not a substantial claim. 5

  • It may state two separate claims as one.

    Findingown data

    Mean SF-12 PCS and MCS scores were 38.4 (SD 6.7) and 39.5 (SD 6.2), which the authors interpreted as substantial disability.

    “The SF-12® PCS and MCS scores were 38.4±6.7 and 39.5±6.2, respectively, indicating substantial disability.”
    • Also stated in: § RESULTS · plain
      “Patients had SF-12 scores denoting significant disability in the phyisical and mental health components.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported surgically diagnosed endometriosis in the registry accurately identifies women who have endometriosis.
    • Rests on an assumption: The 40% response rate did not introduce non-response bias that would alter the findings.

  • It may state two separate claims as one.

    Findingown data

    Women classified as high impact on EHP-5 domains had significantly greater WPAI presenteeism, work productivity loss, and activity impairment than low impact women, but absenteeism did not differ significantly.

    “We observed that, indeed, patients categorized as “high impact” had significantly higher WPAI Presenteeism, Work productivity loss and Activity impairment scores indicating greater impairment and less productivity (Table 4).”
    • Also stated in: § Discussion · plain
      “Also, except for absenteeism, we observed statistically significant differences between patients reporting high vs low impact on EHP-5 domains in all WPAI dimensions.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported surgically diagnosed endometriosis in the registry accurately identifies women who have endometriosis.
    • Rests on an assumption: The Spanish version of EHP-5 used in this study was valid for measuring endometriosis-related HRQoL despite not having been formally translated and validated in Spanish.
    • Rests on an assumption: The WPAI instrument is valid for measuring endometriosis-related work productivity in this population.
    • Rests on an assumption: The 40% response rate did not introduce non-response bias that would alter the findings.

  • It may state two separate claims as one.

    Findingcitation

    Relative to rheumatoid arthritis patients, the endometriosis patients had worse WPAI scores in every domain except absenteeism, where the rates were 13% versus 46%.

    “Compared to patients with rheumatoid arthritis, patients in this study reported worse WPAI outcomes in all domains measured except for absenteeism (13% vs. 46%) (47).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Poole, 2010, A comparison of physician-rated disease severity and patient reported outcomes in mild to moderately active ulcerative colitis, J Crohns Colitis source
    • Rests on an assumption: The WPAI instrument is valid for measuring endometriosis-related work productivity in this population.

  • It may state two separate claims as one. The quote only partly states this claim.

    Findingown data

    Women reported that symptoms substantially affected work productivity, rated as moderate, and daily activities, rated as extreme.

    “Patients reported a substantial impact of symptoms in both work productivity (moderately affected) and daily life activities (extremely affected).”
    • Also stated in: § WPAI: Work Productivity and Activity Impairment Survey Results · plain
      “Based on this scale, loss of productivity had a median of 6.0 (moderately affected) and daily life activities a median of 7.0 (extremely affected).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The WPAI instrument is valid for measuring endometriosis-related work productivity in this population.
    • Rests on an assumption: The week of the last menstrual period or when symptoms were worse is representative of the typical impact of endometriosis symptoms on work and daily activities.

  • It may state two separate claims as one.

    Findingown data

    The most frequently affected QoL areas included mood changes and feeling that others do not understand, each reported by over half of the women.

    “Among QoL domains most commonly affected were changes in mood, and perceptions that no one understands, which were reported by more than half of respondents.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The Spanish version of EHP-5 used in this study was valid for measuring endometriosis-related HRQoL despite not having been formally translated and validated in Spanish.

  • It may state two separate claims as one.

    Findingown data

    The sole significant difference between the mail and online groups was age, with the mail group being older.

    “The only significant difference observed between these two groups was age: patients who responded by regular mail were older than those who responded electronically.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 40% response rate did not introduce non-response bias that would alter the findings.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductown data

    A total of 193 women returned the questionnaire, yielding a 40% response rate.

    “The questionnaire was completed by 193 women, for a response rate of 40%.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 40% response rate did not introduce non-response bias that would alter the findings.

  • It may state two separate claims as one.

    Interpretationown data

    EHP-5 and WPAI scores were associated, which supports using EHP-5 to forecast work-related difficulties in this population.

    “Moreover, we observed an association between EHP-5 and WPAI results, supporting the use of EHP-5 as a tool to predict work-related problems in these patients.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Spanish version of EHP-5 used in this study was valid for measuring endometriosis-related HRQoL despite not having been formally translated and validated in Spanish.
    • Rests on an assumption: The WPAI instrument is valid for measuring endometriosis-related work productivity in this population.

  • It may state two separate claims as one.

    Premisecitation

    The WPAI and SF-12 had prior Spanish translations and validation.

    “WPAI and SF-12® have been translated to Spanish and validated previously (38, 39).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [38] Rodriguez-Merchan, 2003, Health outcome assessment: SF-36 in English and Spanish, Haemophilia source
    • cites [39] Vergara, 2009, Validation of the Spanish Work Productivity and Activity impairment questionnaire: Crohn’s disease version, Eur J Gastroenterol Hepatol source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    SF-12 PCS and MCS scores are normed to a representative US sample, have a mean of 50 with SD 10, and values at or below 40 have been used to indicate significant disability.

    “Thus, SF-12® scores ≥50 represent above average health status and scores of ≤40 have been used as determinant of significant disability (37).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Wilhelm, 2008, What can alert the general practitioner to people whose common mental health problems are unrecognised?, Med J Aust source

  • It may state two separate claims as one.

    Premisecitation

    Endometriosis symptoms harm patients' social wellbeing, damaging relationships, reducing self-esteem, and creating a sense of lost control.

    “Such studies have also shown that endometriosis symptoms negatively impact patients’ social wellbeing, affecting relationships, lowering self-esteem, and leading to a feeling of loss of control (3, 22, 23).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [3] Jones, 2004, The impact of endometriosis upon quality of life: a qualitative analysis, J Psychosom Obstet Gynaecol source
    • cites [22] Lewis, 1987, Bipolar mood disorder and endometriosis: preliminary findings, Am J Psychiatry source
    • cites [23] Low, 1993, A psychological profile of endometriosis patients in comparison to patients with pelvic pain of other origins, J Psychosom Res source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    The EHP-5 was created and validated as a brief endometriosis-specific HRQoL measure.

    “The endometriosis-specific EHP-5 survey was developed and validated in an effort to have a condensed HRQoL instrument that could be used in a time-effective manner during a clinical consult and/or encounters with researchers (29).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Jones, 2004, Development of the Short Form Endometriosis Health Profile Questionnaire: the EHP-5, Qual Life Res source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductreasoning

    To prevent duplicate responses, the study checked participants' initials, birth dates, and surgeon names.

    “Initials, date of birth, and surgeon’s name were used to warrant that participants completed the questionnaire only once.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The EHP-30 and EHP-5 instruments have been translated and validated in multiple populations.

    “The endometriosis-specific surveys EHP-30/EHP-5 have been translated and validated in several populations (25, 30, 31, 44); however, these valuable instruments have not been widely used.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [25] Jenkinson, 2008, Evaluation of the American version of the 30-item Endometriosis Health Profile (EHP-30), Qual Life Res source
    • cites [30] Renouvel, 2009, Linguistic adaptation of the endometriosis health profile 5: EHP 5 [in French], J Gynecol Obstet Biol Reprod (Paris) source
    • cites [31] Mengarda, 2008, Validation of Brazilian Portuguese version of quality of life questionnaire for women with endometriosis (Endometriosis Health Profile Questionnaire—EHP-30) [in Portugese], Rev Bras Ginecol Obstet source
    • cites [44] Choi, 2005, Influencing factors of depression in women with endometriosis [in Korean], Taehan Kanho Hakhoe Chi
14 of 14

  • The paper relies on this without support.

    Before this study, the effect of endometriosis symptoms on work productivity had not been measured with standardized instruments.

    “One important aspect of QoL is work productivity; however, the impact of endometriosis symptoms on this particular area has not been quantified to date using standardized instruments.”
    “To our knowledge, WPAI has not been used before to quantify the impact of endometriosis symptoms on work aspects.”

  • The paper relies on this without support.

    Self-reported surgically diagnosed endometriosis in the registry accurately identifies women who have endometriosis.

    “Women (n=193) with self-reported surgically diagnosed endometriosis from the Endometriosis Patient Registry at Ponce School of Medicine and Health Sciences (PSMHS).”
    “patients with self-reported surgically diagnosed of endometriosis (n=715) and controls (n=246)”

  • The paper relies on this without support.

    The Spanish version of EHP-5 used in this study was valid for measuring endometriosis-related HRQoL despite not having been formally translated and validated in Spanish.

    “EHP-5 had not been translated to Spanish, although its questions were derived from SF-36, which has been previously translated to Spanish.”

  • The paper relies on this without support.

    The sample of 193 women from the PSMHS registry is representative of women with endometriosis in Puerto Rico or more broadly.

    “This cross-sectional study on 193 Puerto Rican women with endometriosis supports the evidence gathered by qualitative studies conducted in other populations indicating that endometriosis-related symptoms have a negative impact on QoL, HRQoL, and work productivity.”

  • The paper relies on this without support.

    The WPAI instrument is valid for measuring endometriosis-related work productivity in this population.

    “to our knowledge, this is the first time WPAI has been applied to an endometriosis patient population.”
    “The Work Productivity and Activity Impairment Questionnaire (WPAI) is a validated instrument that measures the effect of both general and specific symptoms on work productivity and daily tasks (34).”

  • The paper relies on this without support.

    The week of the last menstrual period or when symptoms were worse is representative of the typical impact of endometriosis symptoms on work and daily activities.

    “Patients were instructed to respond these questions according to how they felt during the week of their last menstrual period (when exacerbation of symptoms most commonly occurs) or during the week of the month when symptoms were worse.”

  • The paper relies on this without support.

    The 40% response rate did not introduce non-response bias that would alter the findings.

    “The questionnaire was completed by 193 women, for a response rate of 40%.”
7 of 7

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Metadata

Authors
Fourquet, J., Báez, L., Figueroa, M., Iriarte, R. I., & Flores, I.
Affiliations
Ponce Health Sciences University (PR)
Corresponding author
Flores, Idhaliz
ORCID
Flores, Idhaliz
Venue
Fertility and Sterility
Publisher
Elsevier BV
Published
2011-07
Volume
96
Issue
1
Pages
107-112
ISSN
0015-0282 (ISSN-L)
DOI
10.1016/j.fertnstert.2011.04.095
PMC
PMC3129383
OpenAlex
W1964830755
Semantic Scholar
79811ffdaea9ba8942ee7a3f3519d6c7ea661b5a
Cited by
262
References
52
Citations by year
2026: 13 · 2025: 24 · 2024: 21 · 2023: 17 · 2022: 16 · 2021: 31 · 2020: 28 · 2019: 9 · 2018: 23 · 2017: 18 · 2016: 14 · 2015: 16 · 2014: 12 · 2013: 12 · 2012: 8
FWCI
11.43
Type
journal article
Language
en
Open access
Licence
Locations
  • Fertility and Sterility (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5s06gm008239-23)
  • National Institute of General Medical Sciences (S06 GM-08239, S06-GM 008239)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD050559)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Keywords
endometriosis, endometriosis symptoms, health-related quality of life, labor productivity, absenteeism, presenteeism, activity impairment, physical and mental health, pelvic pain, infertility, women's health
MeSH terms
Activities of Daily Living, Adolescent, Adult, Cross-Sectional Studies, Efficiency, Endometriosis, Female, Health Status Indicators, Health Surveys, Humans, Middle Aged, Quality of Life, Young Adult

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