A multi-centre study of the impact of endometriosis on health-related quality of life and work productivity

Background: Endometriosis is a common condition in women of reproductive age, causing pelvic pain and subfertility, but little is known about its impact on health-related quality of life (HRQoL) and work productivity worldwide.Methods: In 10 countries across five continents, this study recruited 1,418 women, aged 18-45, without a previous surgical diagnosis of endometriosis, scheduled to undergo a laparoscopy to investigate symptoms suggestive of endometriosis or to be sterilised. Pre-operatively, women completed a standardised questionnaire assessing symptoms, diagnostic delay, HRQoL and work productivity using validated instruments. Surgeons completed a standardised questionnaire incorporating findings at laparoscopy including endometriosis stage according to revised American Fertility Society criteria.Results: There was a mean delay of 9.2 years (SD 8.8), principally in primary care, between the onset of symptoms and diagnostic laparoscopy. This diagnostic delay was longer in centres where healthcare was predominantly state-funded (12.8 vs. 7.6 years; pConclusions: Endometriosis significantly 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.This thesis is not currently available in ORA