Long-term impact of chronic pelvic pain on quality of life in women with and without endometriosis

Abstract

Long-term impact of chronic pelvic pain on quality of life in women with and without endometriosis Sayuli Bhide1 , Rebecca Flyckt2, *, Meng Yao3 , Tommaso Falcone4 1 School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA 2Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA 3Department of Quantitative Health Sciences, Lerner Research Institute Cleveland Clinic, Cleveland, OH 44195, USA 4 Cleveland Clinic Lerner College of Medicine, Cleveland Clinic London, SW1X 7AW London, UK *Correspondence: Rebecca.flyckt2@uhhospitals.org (Rebecca Flyckt) DOI:10.31083/j.ceog4804135 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 22 October 2020 Revised: 10 February 2021 Accepted: 19 February 2021 Published: 15 August 2021 Background: Chronic pelvic pain (CPP) has a significant impact on patients' health-related quality of life (HRQoL). Endometriosis is a common cause of CPP. Data is lacking on long-term HRQoL outcomes in patients with endometriosis-associated chronic pelvic pain (EACPP) versus other causes of chronic pelvic pain (OCPP). Methods: In this retrospective single-survey study, 198 patients completed the EHP30 and the patient-reported outcomes measurement information system (PROMIS) Global Health validated questionnaires to assess health-related quality of life (HRQoL) 8–10 years after index surgery. Results: Demographic comparison revealed significant differences in racial demographics and disability status between the EACPP and OCPP groups. There was no significant difference in EHP-30, PROMIS Global Physical, or Global Mental scores between the two groups. Patients with lower stage endometriosis (stage I/II) reported diminished HRQoL in the EHP-30 and Global Physical scores as compared to patients with higher stage (stage III/IV) endometriosis or OCPP. Additionally, no differences were found between incidence of abuse history and EHP-30 and PROMIS scores between the two groups. Higher age and higher PROMIS Global Physical scores were associated with lower pain and higher HRQoL scores on the EHP-30. Persistently high rates of sexual dysfunction were seen across both groups. Discussion: This study demonstrates that women with EACPP and OCPP appear to have similar natural histories and quality of life on long term follow-up. Race, age, disability, and physical health status may play key roles in perceived quality of life. The high rate of persistent sexual dysfunction is concerning and requires increased clinician intervention. Keywords Endometriosis; Quality of life; Abuse; EHP-30; Sexual dysfunction; PROMIS