Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries
Open accessAbstract
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. PATIENT(S): 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. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Diagnostic delay, HRQoL, and work productivity. RESULT(S): 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. CONCLUSION(S): 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.
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A study in 10 countries observed an average diagnostic delay of 6.7 years.
“while a study in 10 countries observed an average delay of 6.7 years.(29)”
From Endometriosis and Risk of Coronary Heart Disease (2016) · cites this paper as [29]
In the UK and several other countries, the average diagnostic delay for endometriosis is 7 years.
“In the UK and several other countries, the average diagnostic delay for endometriosis is 7 years.”
From Risk of cardiovascular outcomes among women with endometriosis in the United Kingdom: a retrospective matched cohort study (2021) · cites this paper as [6]
Endometriosis has a significant negative impact on social life, family, and sexual, educational and professional life.
“Endometriosis has a significant negative impact on aspects of social life, family, and sexual, educational and professional life [27,28,29].”
From Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature) (2021) · cites this paper as [28]
The invasive nature of surgery and the lack of a laboratory biomarker for endometriosis result in a mean latency of 7-11 years from symptom onset to definitive diagnosis.
“the invasive nature of surgery, coupled with the lack of a laboratory biomarker for the disease, results in a mean latency of 7–11 years from onset of symptoms to definitive diagnosis.”
From Update on biomarkers for the detection of endometriosis (2015) · cites this paper as [3]
Loss of work productivity translates into significant costs, ranging from US $208 in Nigeria to US $23,712 in Italy per woman per year.
“Loss of work productivity translated into significant costs, ranging from US $208 in Nigeria to US $23 712 in Italy per woman per year.”
From Defining Future Directions for Endometriosis Research: Workshop Report From the 2011 World Congress of Endometriosis in Montpellier, France (2013) · cites this paper as [7]
Each affected woman loses on average 10.8 hours of work weekly, mainly owing to reduced effectiveness while working.
“Each affected woman lost on average 10.8 hours of work weekly, mainly owing to reduced effectiveness while working.”
From Defining Future Directions for Endometriosis Research: Workshop Report From the 2011 World Congress of Endometriosis in Montpellier, France (2013) · cites this paper as [7]
There is a mean delay of 6.7 years between onset of symptoms and surgical diagnosis of endometriosis.
“there was a delay of mean of 6.7 years, principally in the primary care, between onset of symptoms and a surgical diagnosis of endometriosis”
From Defining Future Directions for Endometriosis Research: Workshop Report From the 2011 World Congress of Endometriosis in Montpellier, France (2013) · cites this paper as [7]
Race/ethnicity is assessed with categories previously used in a worldwide study.
“Race/ethnicity is assessed with categories previously used in a worldwide study (63).”
Endometriosis impairs women's health-related quality of life compared with healthy controls.
“Findings showed that endometriosis impaired women’s HRQoL.”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
Pain is strongly related to poor health-related quality of life in women with endometriosis.
“Pain was strongly related to a poor HRQoL.”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
The impact of disease extent (rAFS stage) on health-related quality of life in endometriosis is inconsistent.
“The impacts of disease extent, duration and fertility status upon HRQoL were inconsistent.”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
No conclusive evidence exists on whether endometriosis imposes additional health-related quality of life impairment beyond that caused by chronic pelvic pain.
“No conclusive evidence was available on whether endometriosis imposed an additional impairment in HRQoL per se, apart from the decrease caused by chronic pelvic pain, or on the superiority of various hormonal suppression agents.”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
The impact of disease duration on health-related quality of life in endometriosis is inconsistent.
“The impacts of disease extent, duration and fertility status upon HRQoL were inconsistent.”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
Endometriosis is associated with greater losses in work productivity and increased sexual dysfunction.
“It was also reported that endometriosis was associated with greater losses in work productivity [3,4,13,17] and increased sexual dysfunction [13].”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
Diagnostic delay worsens health-related quality of life in women with endometriosis.
“No correlation between psychiatric symptoms and diagnosis delay was found in two Brazilian studies [3,16], although a multicenter study revealed that diagnostic delay worsened the HRQoL [4].”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
Income and education level are not associated with health-related quality of life impairment in women with endometriosis.
“Marital status [3,16], income and education level [3,4] were not associated with HRQoL impairment.”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
Advanced rAFS stages negatively influence work productivity and health-related quality of life.
“Advanced rAFS stages were reported to negatively influence work productivity and HRQoL [4,15].”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
Women with endometriosis (n = 745) report more health-related quality of life impairment and work productivity loss than women with similar symptoms (n = 587), especially for the physical component.
“According to the Global Study of Women’s Health, women with endometriosis (n = 745) reported more HRQoL impairment and work productivity loss than those with similar symptoms (n = 587) - especially for the physical component [4].”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
Employed women are significantly less likely to be impacted by endometriosis.
“Employed women were significantly less likely to be impacted by endometriosis [4], as were those who took regular exercise [16].”
From Health-related quality of life in women with endometriosis: a systematic review (2012) · cites this paper as [4]
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- Authors
- Nnoaham, K. E., Hummelshoj, L., Webster, P., d’Hooghe, T., de Cicco Nardone, F., de Cicco Nardone, C., Jenkinson, C., Kennedy, S. H., & Zondervan, K. T.
- Affiliations
- University of Oxford (GB)
- Centre for Human Genetics (GB)
- Corresponding author
- Nnoaham, Kelechi E.
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2011-08
- Volume
- 96
- Issue
- 2
- Pages
- 366-373.e8
- ISSN
- 0015-0282 (ISSN-L)
- PMC
- PMC3679489
- OpenAlex
- W2158134092
- Semantic Scholar
- 6a33390a4859c92b6939df8aa968225d3dadd8d1
- Cited by
- 1,584
- References
- 50
- Citations by year
- 2026: 133 · 2025: 155 · 2024: 188 · 2023: 162 · 2022: 154 · 2021: 148 · 2020: 137 · 2019: 104 · 2018: 80 · 2017: 88 · 2016: 64 · 2015: 63 · 2014: 53 · 2013: 35 · 2012: 18
- FWCI
- 37.72
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Florence Research (University of Florence) (submittedVersion)
- Use Siena air (University of Siena) (submittedVersion)
- Funders
- Wellcome Trust (085235, 090532)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Keywords
- endometriosis, health-related quality of life, labor productivity, delayed diagnosis, primary care, pelvic pain, dysmenorrhea, dyspareunia, menorrhagia, body mass index, premenopausal women
- MeSH terms
- Adolescent, Adult, China, Cross-Sectional Studies, Efficiency, Employment, Endometriosis, Europe, Female, Humans, Middle Aged, Nigeria, Primary Health Care, Prognosis, Prospective Studies, Quality of Life, Surveys and Questionnaires, South America, Time Factors, United States, Chi-Square Distribution, Linear Models, Logistic Models, Cost of Illness, Young Adult, Delayed Diagnosis
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