Quality of life in patients with deep infiltrating endometriosis

DOI

https://dx.doi.org/10.18565/aig.2020.3.116-126

Lisovskaya E.V., Khilkevich E.G., Chuprynin V.D., Melnikov M.V., Ipatova M.V.
Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow

Objective. To analyze the time course of changes in quality-of-life (QoL) indicators in women with deep infiltrating endometriosis (DIE) before and after surgical treatment.
Subjects and methods. The investigation enrolled 93 women with DIE who underwent surgical treatment at the Surgical Department, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, in 2017 to 2019 (a study group); 47 of whom completed the study in 2019, and 31 women without endometriosis (a control group). The SF-36 questionnaire was used to assess QoL in the patients at admission to hospital and 6-8 months after surgical treatment. According to the location of a DIE focus, the study group patients were divided into four subgroups, by using the Enzian classification. QoL indicators in the study group patients were comparatively analyzed according to the size of the largest focus, the presence of infertility, and surgical interventions in the history of patients.
Results. The study confirmed that DIE significantly affected all components of the women’s QoL. The localization of the lesion and its extent had no considerable impact on QoL. Statistically significantly higher indicators were found on the scales of social functioning, vital activity, pain intensity (PI), and physical functioning (PF) in women with complaints of infertility. Comparative characterization of QoL indicators in women with a history of surgical treatment revealed that the indicators were statistically significantly higher (p < 0.05) on the scales of PI, PF, and a physical health component. Surgical treatment leads to an improvement in all QoL indicators in women with DIE at 6-8 months postsurgery. There were no statistically significant differences on the scales of overall-health self-assessment, PF, and role emotional functioning.
Conclusion. DIE leads to a significant decrease in all QoL indicators in women, regardless of the location of a focus and its sizes. QoL in women with DIE, the main complaint of which is infertility, is higher than that in those who have an extensive clinical symptomatology of the disease, but do not suffer from infertility. Surgical removal of foci is an effective method with a long partial effect; however, it should be likely to be supplemented with psychotherapy.

deep infiltrating endometriosis

quality of life

surgical treatment

Full text (in Russian)

Ware J.E., Kosinski M., Keller S. SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Boston, MA: Health Assessment Lab, 1994. https://www.researchgate.net/publication/292390260
Arcoverde F.V.L., Andres M.P., Borrelli G.M., Barbosa P.A., Abrão M.S., Kho R.M. Surgery for Endometriosis Improves Major Domains of Quality of Life: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol. 2019; 26(2): 266–78. doi: 10.1016/j.jmig.2018.09.774
Bourdel N., Chauvet P., Billone V., Douridas G., Fauconnier A., Gerbaud L., et al. Systematic review of quality of life measures in patients with endometriosis. PLoS One. 2019; 14(1): e0208464. doi: 10.1371/journal.pone.0208464
Адамян Л.В., ред. Эндометриоз: Диагностика, лечение и реабилитация. Федеральные клинические рекомендации по ведению больных (проект), 2013. [Adamyan L.V., ed. Endometriosis: Diagnosis, treatment and rehabilitation. Federal Clinical Guidelines for Patient Management (draft), 2013. (In Russ.)]
Рябцева М.В., Кира Е.Ф. Оценка качества жизни при эндометриоидной болезни. Журнал акушерства и женских болезней. 2008; 52(1): 63–5. [Ryabtseva M.V., Kira E.F. The Estimations of Quality of Life at Patients with Endometriosis. Zhurnal akusherstva i zhenskikh bolezney. 2008; 52(1): 63–5. (In Russ.)].
Friedl F., Riedl D., Fessler S., Wildt L., Walter M., Richter R., et al. Impact of endometriosis on quality of life, anxiety, and depression: an Austrian perspective. Arch Gynecol Obstet. 2015; 292(6): 1393–9. doi: 10.1007/s00404-015-3789-8
De Graaff A.A., D’Hooghe T.M., Dunselman G.A., Dirksen C.D., Hummelshoj L.; WERF EndoCost Consortium, Simoens S. The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod. 2013; 28(10): 2677–85. doi: 10.1093/humrep/det284
Facchin F., Barbara G., Saita E., Mosconi P., Roberto A., Fedele L., et al. Impact of endometriosis on quality of life and mental health: Pelvic pain makes the difference. J Psychosom Obstet Gynecol. 2015; 36:135–41. doi: 10.3109/0167482X.2015.1074173
Centini G., Lazzeri L., Dores D. Chronic pelvic pain and quality of life in women with and without endometriosis. J Endometr Pelvic Pain Disord. 2013; 5: 27–33. doi:10.5301/je.5000148
Márki G., Bokor A., Rigó J., Rigó A. Physical pain and emotion regulation as the main predictive factors of health-related quality of life in women living with endometriosis. Hum Reprod. 2017; 32(7): 1432–8. doi: 10.1093/humrep/dex091
Nnoaham K.E., Hummelshoj L., Webster P., d’Hooghe T., de Cicco Nardone F., de Cicco Nardone C., et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011; 96(2): 366–73.e8. doi: 10.1016/j.fertnstert.2011.05.090
Mathias S.D., Kuppermann M, Liberman R.F., Lipschutz R.C., Steege J.F. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996; 87: 321–7. doi: 10.1016/0029-7844(95)00458-0
Souza C.A., Oliveira L.M., Scheffel C., Genro V.K., Rosa V., Chaves M.F., et al. Quality of life associated to chronic pelvic pain is independent of endometriosis diagnosis--a cross-sectional survey. Health Qual Life Outcomes. 2011; 9: 41. doi: 10.1186/177-7525-9-41
Tripoli T.M., Sato H., Sartori M.G., de Araujo F.F., Girão M.J., Schor E. Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis. J Sex Med. 2011; 8(2): 497–503. doi: 10.1111/j.1743-6109.2010.01976.x
Laursen B.S., Bajaj P., Olesen A.S., Delmar C., Arendt-Nielsen L. Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain. Eur J Pain. 2005; 9(3): 267–75. doi: 10.1016/j.ejpain.2004.07.003
Мan Aken M.A.W., Oosterman J.M., van Rijn C.M., Ferdek M.A., Ruigt G.S.F., Peeters B.W.M.M., et al. Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment. Fertil Steril. 2017; 108(4): 679–86. doi: 10.1016/j.fertnstert.2017.07.016
Stratton P., Khachikyan I., Sinaii N., Ortiz R., Shah J., Stratton P., et al. Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain. Obstet Gynecol. 2015; 125: 719–28. doi: 10.1097/AOG.0000000000000663
Garry R., Clayton R., Hawe J. The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG. 2000; 107: 44–54. doi: 10.1111/j.1471-0528.2000.tb11578.x
Tariverdian N., Theoharides T.C., Siedentopf F., Gutiérrez G., Jeschke U., Rabinovich G.A., et al. Neuroendocrine-immune disequilibrium and endometriosis: an interdisciplinary approach. Semin Immunopathol. 2007; 29: 193–210. doi: 10.1007/s00281-007-0077-0
Gross J.J., Barrett L.F. Emotion generation and emotion regulation: one or two depends on your point of view. Emot Rev. 2011; 3: 8–16. doi: 10.1177/1754073910380974
Gyurak A., Gross J.J., Etkin A. Explicit and implicit emotion regulation: a dual-process framework. Cogn Emot 2011; 25: 400–12. doi: 10.1080/02699931.2010.544160
Gatchel R.J. Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. Am Psychol. 2004; 59: 795–805. doi:10.1037/0003-066X.59.8.795
John O.P., Gross J.J. Healthy and unhealthy emotion regulation: personality processes, individual differences, and life span development. J Pers. 2004; 72:1301–33. doi: 10.1111/j.1467-6494.2004.00298.x
Carey E.T., Martin C.E., Siedhoff M.T., Bair E.D., As-Sanie S. Biopsychosocial correlates of persistent postsurgical pain in women with endometriosis. Int J Gynaecol Obstet. 2014; 124: 169–73. doi: 10.1016/j.ijgo.2013.07.033
Cousineau T.M., Domar A.D. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007; 21(2): 293–308. doi: 10.1016/j.bpobgyn.2006.12.003
Zurlo M.C., Cattaneo Della Volta M.F., Vallone F. Predictors of quality of life and psychological health in infertile couples: the moderating role of duration of infertility. Qual Life Res. 2018; 27(4): 945–54. doi: 10.1007/s11136-017-1781-4
Peterson B.D., Sejbaek C.S., Pirritano M., Schmidt L. Are severe depressive symptoms associated with infertility-related distress in individuals and their partners? Hum Reprod. 2014; 29(1): 76–82. doi: 10.1093/humrep/det412
Maroufizadeh S., Hosseini M., Rahimi Foroushani A., Omani-Samani R., Amini P. The effect of depression on quality of life in infertile couples: an actor-partner interdependence model approach. Health Qual Life Outcomes. 2018; 16(1): 73. doi: 10.1186/s12955-018-0904-0
Wischmann T.H. Psychogenic infertility--myths and facts. J Assist Reprod Genet. 2003; 20(12): 485–94. doi: 10.1023/b:jarg.0000013648.74404.9d
Wullschleger M.F., Imboden S.., Wanner J., Mueller M.D. Minimally invasive surgery when treating endometriosis has a positive effect on health and on quality of work life of affected women. Hum Reprod. 2015; 30(3): 553–7. doi: 10.1093/humrep/deu356
Dubernard G., Piketty M., Rouzier R., Houry S., Bazot M., Darai E. Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod. 2006; 21: 1243–7. doi: 10.1093/humrep/dei491
Raimondo D.., Mattioli G., Esposti E.D., Gregori B., Forno S.D., Mastronardi M., et al. Impact of temporary protective ileostomy on intestinal function and quality of life after a 2-year follow-up in patients submitted to colorectal segmental resection for endometriosis. J Minim Invasive Gynecol. 2019; pii: S1553-4650(19)31279-8. doi: 10.1016/j.jmig.2019.10.017
Valentin L., Canis M., Pouly J.L., Lasnier C., Jaffeux P., Aublet-Cuvelier B., et al. Bourdel SF-36 preoperative interest of predicting improvement of quality of life after laparoscopic management of minimal endometriosis. J Gynecol Obstet Hum Reprod. 2017; 46(2): 137–42. doi: 10.1016/j.jogoh.2016.12.004
Touboul C., Ballester M., Dubernard G., Zilberman S., Thomin A., Daraï E. Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery. Surg Endosc. 2015; 29(7): 1879–87. doi: 10.1007/s00464-014-3880-4
Montanari E., Dauser B., Keckstein J., Kirchner E., Nemeth Z., et al. Association between disease extent and pain symptoms in patients with deep infiltrating endometriosis. Reprod Biomed Online. 2019; 39(5): 845–51. doi: 10.1016/j.rbmo.2019.06.006
Haas D., Oppelt P., Shebl O., Shamiyeh A., Schimetta W. et al. Enzian classification: does it correlate with clinical symptoms and the rASRM score? Acta. Obstet. Gynecol. Scand. 2013; 92: 562–6. doi: 10.1111/aogs.12118.
Nunes F.R, Ferreira J.M, Bahamondes L. Prevalence of fibromyalgia and quality of life in women with and without endometriosis. Gynecol Endocrinol. 2014; 30: 307–10. doi: 10.3109/09513590.2013.876401
Minson F.P., Abrao M.S., Sarda Junior J., Kraychete D.C, Podgaec S., Assis F.D. Importance of quality of life assessment in patients with endometriosis. Rev Bras Ginecol Obstet 2012; 34: 11–15. PMID: 22358342
Szendei G., Hernadi Z., Devenyi N. et al. Is there any correlation between stages of endometriosis and severity of chronic pelvic pain? Possibilities of treatment. Gynecol Endocrinol. 2005; 21: 93–100. doi: 10.1080/09513590500107660
Fassino S., Pierò A., Boggio S., Piccioni V., Garzaro L. Anxiety, depression and anger suppression in infertile couples: a con-trolled study. Hum Reprod. 2002; 17(11): 2986–94.
El Kissi Y., Romdhane A.B., Hidar S., et al. General psychopathology, anxiety, depression and self-esteem in couples undergoing infer-tility treatment: a comparative study between men and women. Eur J Obstet Gynecol Reprod Biol. 2013;167(2):185–9.
Ribeiro P.A., Sekula V.G., Abdalla-Ribeiro H.S., Rodrigues F.C., Aoki T., Aldrighi J.M. Impact of laparoscopic colorectal segment resection on quality of life in women with deep endometriosis: one year follow-up. Qual Life Res. 2014; 23(2): 639–43. doi: 10.1007/s11136-013-0481-y

Received 15.01.2020

Accepted 07.02.2020

Ekaterina V. Lisovskaya, obstetrician-gynecologist of the surgical department of the department of operative gynecology and general surgery, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. Tel.: +7 (495) 438-78-33.
E-mail: e_lisovskaya@oparina4.ru
Address:117997, Russia, Moscow, Ac. Oparina str. 4.
Elena G. Khilkevich, MD, obstetrician–gynecologist of the Surgery Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named
after Academician V.I. Kulakov, Ministry of Health of Russia. Tel.: +7 (495)438-78-33. E–mail: e_khilkevich@oparina4.ru. ORCID ID: 0000–0001–8826–8439
Address:117997, Russia, Moscow, Ac. Oparina str. 4.
Vladimir D. Chuprynin, PhD, Head of the Surgery Department, National Medical Research Center for Obstetrics, Gynecology, and Perinatology named
after Academician V.I. Kulakov, Ministry of Health of Russia. Tel.: +7(495) 438-78-33. E–mail: v_chuprynin@oparina4.ru
Address:117997, Russia, Moscow, Ac. Oparina str. 4.
Mikhail V. Melnikov, candidate of medical sciences, head. on the clinical work of the surgical department of the Department of Operative Gynecology and General Surgery, National Medical Research Center for Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia.
Tel.: +7 (495) 438-78-33. E-mail: m_melnikov@oparina4.ruAddress: 117997, Russia, Moscow, ul. Academician Oparin, d. 4.
Ipatova Marina V., PhD, head of the gynecology department of Rehabilitation National Medical Research Center for Obstetrics, Gynecology and Perinatology named
after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation. Tel.:+7 (495)438-23-44. E-mail: m_ipatova@oparina4.ru
117997 Russian Federation, Moscow, Oparin street, 4.

For citation: Lisovskaya E.V., Khilkevich E.G., Chuprynin V.D., Melnikov M.V., Ipatova M.V. Quality of life in patients with deep infiltrating endometriosis.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2020; 3: 116-26. (In Russian).
https://dx.doi.org/10.18565/aig.2020.3.116-126

Quality of life in patients with deep infiltrating endometriosis

Lisovskaya E.V., Khilkevich E.G., Chuprynin V.D., Melnikov M.V., Ipatova M.V.

Keywords

References

About the Authors

Similar Articles