Patients with severe endometriosis and pelvic pain show the most pronounced improvements in quality of life within one year after undergoing laparoscopic surgery, a new study reports.
Laparoscopic surgery is the current gold standard to treat endometriosis. A small incision is made to allow a tool called a laparoscope, coupled with a small camera, to go inside the abdomen to guide the removal of endometriosis lesions.
Although surgery has the potential to reduce pain and improve patients’ quality of life, it is crucial to evaluate how surgery is affecting physical and mental health as well as patients’ social well-being.
Endometriosis often causes chronic pelvic pain, severe pain during menstruation (dysmenorrhea), and pain during sex (dyspareunia). Other non-gynecologic symptoms include constipation, diarrhea, and rectal bleeding. Together, these symptoms have a significant impact on patients’ quality of life.
In order to investigate which factors led to changes in patients’ quality of life, a team of researchers analyzed 981 patients from five districts in the Auvergne region of France who underwent laparoscopic treatment between 2004 and 2012.
Enrolled participants, ages 15-50, had received laparoscopic surgery or been newly diagnosed with a histological confirmation of endometriosis.
The team compared quality of life prior to surgery and one year after surgery using the 36-Item Short Form (SF-36) questionnaire, data on presence or absence of specific symptoms, and intensity of pain. Improvement in quality of life was measured using effect size method (ES), in which a value of 0.8 or higher corresponds to a significant improvement.
The SF-36 consists of eight sections covering physical functioning, energy/fatigue, bodily pain, role limitations due to physical health, general health perception, social functioning, role limitations due to emotional problems, and emotional well-being. The lower the score in the questionnaire, the greater the disability.
In total, 44% of patients with endometriosis and chronic pelvic pain had an improvement in quality of life equal to or above 0.8 ES compared to 23% of patients without pain who had similar ES scores.
Moreover, 47% of patients with stage 4 endometriosis had an ES score above 0.8, whereas only 26%, 31%, and 27.5% of patients in stage I, II, and III respectively had a similar improvement in quality of life.
Researchers observed that patients with chronic pelvic pain were more likely to improve their quality of life after surgery compared to those without it. Fertile patients also were more likely to improve quality of life compared to infertile patients.
Mental health of patients with chronic pelvic pain was also improved after surgery compared to patients without pain.
Similarly, patients with anxiety also showed better mental score compared to non-anxious patients.
Overall, researchers found that chronic pelvic pain was the most significant factor in predicting patients’ improvement in quality of life after surgery.
“Patients presenting with severe endometriosis and who experience higher levels of pain are more likely to show improvement in [quality of life] after surgery,” researchers said.
“[Chronic pelvic pain] is the most significant independent predictive factor for changes in QoL scores,” the study concluded.
The study, “Identification of predictive factors in endometriosis for improvement in patient quality of life,” was published in the Journal of Minimally Invasive Gynecology.