By I.Soussis MD,MSc,FRCOG, Fertility Specialist
Women with endometriosis experience debilitating fatigue more than twice as often as those who don’t have the condition, yet fatigue isn’t discussed or researched widely enough in these patients, a recent study concluded.
The international study found that high levels of fatigue experienced by women with endometriosis are independent of other factors, such as insomnia, pain, depression, occupational stress, weight, and motherhood.
The study “Fatigue – a symptom in endometriosis,” was published in the journal Human Reproduction.
Fatigue is a known symptom of endometriosis that affects the daily activities and quality of life of women living with the condition. But scientists and physicians lack large population studies investigating the frequency of fatigue in women with the disease.
Researchers designed a multicenter study that recruited 1,120 women (560 with endometriosis and 560 without it), at hospitals and private practices in Switzerland, Germany, and Austria between 2010 and 2016.
Participants responded to a questionnaire focused on several factors associating quality of life with endometriosis, as well as family and medical histories, mental disorders, and lifestyle. Fatigue and insomnia were classified at five different levels, with 1 being “never” and 5 being “very often.”
Responses showed that frequent fatigue was experienced by more than half of the women with endometriosis (50.7 percent) but by only a minority of women who didn’t have endometriosis (22.4 percent).
The study also found a link between fatigue in endometriosis and insomnia (women with endometriosis had a seven-fold increase in insomnia compared with healthy women), depression (a four-fold increase), pain (a two-fold increase), and occupational stress (nearly a 1.5-fold increase). However, no correlation was seen between the above symptoms and age, disease stage, and time since diagnosis.
Endometriosis leads to inflammation and an activation of the immune system, which may help to explain the link between endometriosis and fatigue, researchers said.
Proteins that are produced when the immune system is activated are known to be involved in fatigue symptoms. Also, chronic exposure to high stress can lead to fatigue, and researchers said this could be an additional explanation.
“These findings suggest that endometriosis has an effect on fatigue that is independent of other factors and that cannot be attributed to symptoms of the disease,” Brigitte Leeners, the study’s lead researcher and deputy head of the Department of Reproductive Endocrinology at the University Hospital Zurich, in Switzerland, said.
“We believe that in order to improve the quality of life for women with this condition, investigating and addressing fatigue should become a routine part of medical care, and doctors should investigate and address this problem when they are discussing with their patients the best ways to manage and treat the disease”. It would also help these women if steps were taken to reduce insomnia, pain, depression and occupational stress,” she added.