Psychoemotional aspects and somatic status of women with endometriosis: is there a link?

DOI

https://dx.doi.org/10.18565/aig.2024.185

Managadze I.D., Nesterova A.A., Levakova O.S., Levakov S.A.
1) I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia; 2) Clinical Hospital No. 85, Federal Medical Biological Agency, Moscow, Russia

Endometriosis is a chronic inflammatory disease characterized by the presence of endometriosis-like tissue outside the uterus. Every ninth woman is diagnosed with this pathology, and most women experience dysmenorrhea, non-menstrual pelvic pain, asthenia and infertility. According to its location, endometriosis is divided into extragenital and genital endometriosis, which in turn is subdivided into external and internal one. The present review focuses on the genital form in particular. Endometriosis should be considered as a systemic, not only gynecological disease, therefore it is important to study the psychosocial mechanisms of its development. Endometriosis is currently known to be accompanied by significant psychosomatic and social discomfort. Further research is required to identify the complex of psychosomatic factors affecting women with this disease, to determine how these factors interact with one another, and how they contribute to the pathogenesis of the disease. The article presents the current data of the world literature on the psychoemotional status of patients with endometriosis. The paper considers a wide range of relevant psychosomatic issues of endometriosis, including the pathogenesis of chronic pelvic pain in terms of psychoemotional disorders, the interrelationship between psychoemotional factors such as body image, self-compassion, catastrophizing of pain, perception of illness, as well as problems of stigmatization and sexual dysfunction.
Conclusion: The literature review demonstrates that endometriosis is a complex disease where the psychological factors of emotional distress and cognition play an important role. This emphasizes the need to identify psychosomatic factors affecting patients with endometriosis and common links in pathogenesis. It is necessary to further investigate psychological symptoms and determine possible prevention and treatment approaches aimed at eliminating these predictors and improving the quality of women’s lives.

Authors’ contributions: Levakov S.A. – developing the concept and design of the study; Managadze I.D. – collection and analysis of the literary data, writing the text; Nesterova A.A., Levakova O.S. – editing the article.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Managadze I.D., Nesterova A.A., Levakova O.S., Levakov S.A.
Psychoemotional aspects and somatic status of women with endometriosis: is there a link?
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (11): 21-33 (in Russian)
https://dx.doi.org/10.18565/aig.2024.185

endometriosis

chronic pelvic pain

affective disorders

anxiety

depression

psychoemotional status

endometriosis treatment

endometriosis diagnosis

psychological aspects of endometriosis

Full text (in Russian)

Министерство здравоохранения Российской Федерации. Клинические рекомендации. Эндометриоз. М.; 2020. 60 с. [Ministry of Health of the Russian Federation. Clinical guidelines. Endometriosis. Moscow; 2020. 60 p.(in Russian)].
Dowding C., Mikocka-Walus A., Skvarc D., Van Niekerk L., O'Shea M., Olive L. et al. The temporal effect of emotional distress on psychological and physical functioning in endometriosis: a 12 month prospective study. Appl. Psychol. Health Well Being. 2023; 15(3): 901-18. https://dx.doi.org/10.1111/aphw.12415.
van Stein K., Schubert K., Ditzen B., Weise C. Understanding psychological symptoms of endometriosis from a research domain criteria perspective. J. Clin. Med. 2023; 12(12): 4056. https://dx.doi.org/10.3390/jcm12124056.
Fiala L., Lenz J., Adamik Z., Sajdlova R., Kestlerova D., Vetvicka V. Psychological hallmarks of endometriosis with emphasis on sexual dysfunction, stress, anxiety and depressive symptoms. Int. Clin. Pathol. J. 2023; 10(1): 45-8. https://dx.doi.org/10.15406/icpjl.2023.10.00218.
Králíčková M., Vetvicka V., Fiala L., Laganà A.S., Garzon S. The search for biomarkers in endometriosis: a long and windy road. Reprod. Sci. 2022; 29(6): 1667-73. https://dx.doi.org/10.1007/s43032-021-00668-2.
Sherman K.A., Przezdziecki A, Alcorso J., Kilby C.J., Elder E., Boyages J., Koelmeyer L., Mackie H. Reducing body image–related distress in women with breast cancer using a structured online writing exercise: results from the my changed body randomized controlled trial. J. Clin. Oncol. 2018; 36(19):1930-40. https://dx.doi.org/10.1200/JCO.2017.76.3318.
Van Niekerk L., Bromfield H., Matthewson M. Physical and psychological correlates of self and body compassion in women with polycystic ovary syndrome. J. Health Psychol. 2022; 27(11): 2566-80.https://dx.doi.org/10.1177/13591053211059390.
Schubert K., Lohse J., Kalder M., Ziller V., Weise C. Internet-based cognitive behavioral therapy for improving health-related quality of life in patients with endometriosis: study protocol for a randomized controlled trial. Trials. 2022; 23(1): 300. https://dx.doi.org/10.1186/s13063-022-06204-0.
Gonçalves A.V., Barros N.F., Bahamondes L. The practice of Hatha Yoga for the treatment of pain associated with endometriosis. J. Altern. Complement Med. 2017; 23(1): 45-52. https://dx.doi.org/10.1089/acm.2015.0343.
Meissner K., Schweizer-Arau A., Limmer A., Preibisch C., Popovici R.M., Lange I. et al. Psychotherapy with somatosensory stimulation for endometriosis-associated pain: a randomized controlled trial. Obstet. Gynecol. 2016; 128(5): 1134-42. https://dx.doi.org/10.1097/AOG.0000000000001691.
da Costa V.F.D.D., Gonçalves M.E.P.M., dos Santos Leite C., Pires O.C. Approach to pain in endometriosis patients: systematic literature review. J. Biosci. Med. 2022; 10(11); 1-27. https://dx.doi.org/10.4236/jbm.2022.1011001.
Cozzolino M., Coccia M.E., Lazzeri G., Basile F., Troiano G. Variables associated with endometriosis-related pain: a pilot study using a visual analogue scale. Rev. Bras. Ginecol. Obstet. 2019; 41(3):170-5.https://dx.doi.org/10.1055/s-0039-1679879.
Hernandes C., Gueuvoghlanian-Silva B.Y., Monnaka V.U., Ribeiro N.M., Pereira W.O., Podgaec S. Regulatory T cells isolated from endometriotic peritoneal fluid express a different number of Toll-like receptors. Einstein (Sao Paulo). 2020; 18: eAO5294. https://dx.doi.org/10.31744/einstein_journal/2020AO5294.
Silva J.B.D., Gurian M.B.F., Nonino C.B., Poli-Neto O.B., Nogueira A.A., Reis F.J.C.D. et al. Analysis of body composition and pain intensity in women with chronic pelvic pain secondary to endometriosis. Revista Brasileira de Ginecologia e Obstetrícia. 2020; 42(8); 486-92. https://dx.doi.org/10.1055/s-0040-1713912.
Гуменюк Л.Н., Гаврилов М.В., Пучкина Г.А., Чотчаев Р.М., Заурова М.Б., Иваненко О.И., Ланец И.Е., Энзель Д.А. Особенности сексуального функционирования, психоэмоционального статуса и качества жизни пациенток с наружным генитальным эндометриозом и инсомнией. Акушерство и гинекология. 2023; 6: 107-14. [Gumenyuk L.N., Gavrilov M.V., Puchkina G.A., Chotchaev R.M., Zaurova M.B., Ivanenko O.I., Lanets I.E., Enzel D.A. Sexual functioning, psycho-emotional status and quality of life in patients with extragenital endometriosis and insomnia. Obstetrics and Gynecology. 2023; (6): 107-14. (in Russian)]. https://dx.doi.org/10.18565/aig.2023.46.
Evans S., Fernandez S., Olive L., Payne L.A., Mikocka-Walus A. Psychological and mind-body interventions for endometriosis: a systematic review. J. Psychosom. Res. 2019; 124: 109756. https://dx.doi.org/10.1016/j.jpsychores.2019.109756.
Бегович Ё., Байгалмаа Б., Солопова А.Г., Бицадзе В.О., Хизроева Д.Х., Сон Е.А., Зобаид Ш.Х., Быковщенко Г.К. Качество жизни как критерий оценки эффективности реабилитационных программ у пациенток с болевой формой наружного генитального эндометриоза. Акушерство, гинекология и репродукция. 2023; 17(1): 92-103. [Begovich E.,Baigalmaa B., Solopova A.G., Bitsadze V.O., Khizroeva J.Kh., Son E.A., Zobaid Sh.Kh., Bykovshchenko G.K. Quality of life as a criterion for assessing the effectiveness of rehabilitation programs in patients with painful external genital endometriosis. Obstetrics, Gynecology and Reproduction. 2023; 17(1): 92-103. (in Russian)]. https://dx.doi.org/10.17749/2313-7347/ob.gyn.rep.2023.391.
Бегович Ё., Солопова А.Г., Хлопкова С.В., Сон Е.А., Идрисова Л.Э. Качество жизни и особенности психоэмоционального статуса больных наружным генитальным эндометриозом. Акушерство, гинекология и репродукция. 2021; 16(2): 122-33. [Begovich E., Solopova A.G., Khlopkova S.V., Son E.A., Idrisova L.E. Quality of life and psychoemotional status in patients with external genital endometriosis. Obstetrics, Gynecology and Reproduction. 2022; 16(2): 122-33. (in Russian)]. https://dx/doi.org/10.17749/2313-7347/ob.gyn.rep.2022.283.
Till S.R., As-Sanie S., Schrepf A. Psychology of chronic pelvic pain: prevalence, neurobiological vulnerabilities, and treatment. Clin. Obstet. Gynecol. 2019; 62(1): 22-36. https://dx.doi.org/10.1097/GRF. 0000000000000412.
Appleyard C.B., Flores I., Torres-Reverón A. The link between stress and endometriosis: from animal models to the clinical scenario. Reprod. Sci. 2020; 27(9): 1675-86. https://dx/doi.org/10.1007/s43032-020-00205-7.
Liebermann C., Kohl Schwartz A.S., Charpidou T., Geraedts K., Rauchfuss M., Wölfler M. et al. Maltreatment during childhood: a risk factor for the development of endometriosis? Hum. Reprod. 2018; 33(8): 1449-58. https://dx.doi.org/1010.1093/humrep/dey111.
Nielsen L.J., Poulsen K., Funch A.L., Petersen K.S. The lived experiences of endometriosis in adolescence-A critical hermeneutic perspective. Scand. J. Caring Sci. 2023; 37(4): 1038-47. https://dx.doi.org/10.1111/scs.13176.
Kleinman A. The illness narratives: suffering, healing, and the human condition. 2nd ed. New York: Basic Books; 2020.
Missmer S.A., Tu F., Soliman A.M., Chiuve S., Cross S., Eichner S. et al. Impact of endometriosis on women's life decisions and goal attainment: a cross-sectional survey of members of an online patient community. BMJ Open. 2022; 12(4): e052765. https://dx.doi.org/1010.1136/bmjopen-2021-052765.
Pessoa de Farias Rodrigues M., Lima Vilarino F., de Souza Barbeiro Munhoz A. et al. Clinical aspects and the quality of life among women with endometriosis and infertility: a cross-sectional study. BMC Womens Health. 2020; 20(1):124. https://dx.doi.org/10.1186/s12905-020-00987-7.
Hållstam A., Stålnacke B.M., Svensén C., Löfgren M. Living with painful endometriosis - A struggle for coherence. A qualitative study. Sex. Reprod. Healthc. 2018; 17: 97-102. https://dx.doi.org/10.1016/j.srhc.2018.06.002.
Rush G., Misajon R. Examining subjective wellbeing and health-related quality of life in women with endometriosis. Health Care Women Int. 2018; 39(3): 303-21. https://dx.doi.org/10.1080/07399332.2017.1397671.
Лисовская Е.В., Хилькевич Е.Г., Чупрынин В.Д., Мельников М.В., Ипатова М.В. Качество жизни женщин с глубоким инфильтративным эндометриозом. Акушерство и гинекология. 2020; 3: 116-26. [Lisovskaya E.V., Khilkevich E.G., Chuprynin V.D., Melnikov M.V., Ipatova M.V. Quality of life in patients with deep infiltrating endometriosis. Obstetrics and Gynecology. 2020; (3): 116-26. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.3.116-126.
La Rosa V.L., Commodari E., Vitale S.G. Psychological considerations in endometriosis. In: Oral E. ed. Endometriosis and adenomyosis. Springer, Cham; 2022: 309-28. https://dx.doi.org/10.1007/978-3-030-97236-3_25.
Sherman K.A., Pehlivan M.J., Redfern J., Armour M., Dear B., Singleton A. et al. A supportive text message intervention for individuals living with endometriosis (EndoSMS): randomized controlled pilot and feasibility trial. Contemp. Clin. Trials Commun. 2023; 32: 101093. https://dx.doi.org/10.1016/j.conctc.2023.101093.
Moore C., Williams L., Cogan N. "It's like a constant black cloud": a qualitative investigation of the impact of endometriosis on quality of life. Abstract from 15th World Congress on Endometriosis. 2023, May 2-3,Edinburgh; 2023.
Van Niekerk L.M., Dell B., Johnstone L., Matthewson M., Quinn M. Examining the associations between self and body compassion and health related quality of life in people diagnosed with endometriosis. J. Psychosom. Res. 2023; 167: 111202. https://dx.doi.org/10.1016/j.jpsychores.2023.111202.
Moore C., Cogan N., Williams L. A qualitative investigation into the role of illness perceptions in endometriosis-related quality of life. J. Health Psychol. 2023; 28(12): 1157-71. https:/dx./doi.org/10.1177/13591053231183230.
Pehlivan M.J., Sherman K.A., Wuthrich V., Gandhi E., Zagic D., Kopp Ep, Perica V. The effectiveness of psychological interventions for reducing poor body image in endometriosis, PCOS and other gynaecological conditions: a systematic review and meta-analysis. Health Psychol. Rev. 2023; 18(1): 1-28. https://dx.doi.org/10.1080/17437199.2023.2245020.
Chow K.M., Chan C.W.H., Law B.M.H. Perceptions of Chinese patients treated for gynaecological cancer about sexual health and sexual information provided by healthcare professionals: a qualitative study. Cancers (Basel). 2021;13(7):1654. https://dx.doi.org/10.3390/cancers13071654.
Lewis-Smith H., Diedrichs P.C., Rumsey N., Harcourt D. Efficacy of psychosocial and physical activity-based interventions to improve body image among women treated for breast cancer: A systematic review. Psychooncology. 2018; 27(12): 2687-99. https://dx.doi.org/10.1002/pon.4870.
Van Niekerk L., Weaver-Pirie B., Matthewson M. Psychological interventions for endometriosis-related symptoms: a systematic review with narrative data synthesis. Arch. Womens Ment. Health. 2019; 22(6): 723-35.https://dx.doi.org/10.1007/s00737-019-00972-6.
Moradi F., Ghadiri-Anari A., Dehghani A., Reza Vaziri S., Enjezab B. The effectiveness of counseling based on acceptance and commitment therapy on body image and self-esteem in polycystic ovary syndrome: An RCT. Int. J. Reprod. Biomed. 2020; 18(4): 243-52. https://dx.doi.org/10.18502/ijrm.v13i4.6887.
Sullivan-Myers C., Sherman K.A., Beath A.P., Cooper M.J.W., Duckworth T.J. Body image, self-compassion, and sexual distress in individuals living with endometriosis. J. Psychosom. Res. 2023; 167: 111197.https://dx.doi.org/10.1016/j.jpsychores.2023.111197.
Melis I., Litta P., Nappi L., Agus M., Melis G.B., Angioni S. Sexual function in women with deep endometriosis: correlation with quality of life, intensity of pain, depression, anxiety, and body image. Int. J. Sex. Health. 2015; 27(2):175-85. https://dx.doi.org/10.1080/19317611.2014.952394.
Van Niekerk L., Steains E., Matthewson M. Correlates of health-related quality of life: The influence of endometriosis, body image and psychological wellbeing. J. Psychosom. Res. 2022; 161: 110993. https://dx.doi.org/10.1016/j.jpsychores.2022.110993.
Van Niekerk L., Johnstone L., Matthewson M. Predictors of self-compassion in endometriosis: the role of psychological health and endometriosis symptom burden. Hum. Reprod. 2022; 37(2): 264-73. https://dx.doi.org/10.1093/humrep/deab257.
Neff K.D. Self-compassion: theory, method, research, and intervention. Annu. Rev. Psychol. 2023; 74: 193-218. https://dx.doi.org/10.1146/annurev-psych-032420-031047.
de Carvalho Barreto M., Ferreira C., Marta-Simões J., Mendes A.L. Exploring the paths between self-compassionate attributes and actions, body compassion and disordered eating. Eat Weight Disord. 2020; 25(2): 291-7.https://dx.doi.org/10.1007/s40519-018-0581-3.
Endometriosis UK. Press release: time to end the stigma. 2022. Available at: https://www.endometriosis-uk.org/press-release-time-end-stigma
Leone Roberti Maggiore U., Chiappa V., Ceccaroni M., Roviglione G., Savelli L., Ferrero S. et al. Epidemiology of infertility in women with endometriosis. Best Pract. Res. Clin. Obstet. Gynaecol. 2024; 92: 102454.https://dx.doi.org/.10.1016/j.bpobgyn.2023.102454.
Kocas H.D., Rubin L.R., Lobel M. Stigma and mental health in endometriosis. Eur. J. Obstet. Gynecol. Reprod. Biol X. 2023; 19: 100228.https://dx.doi.org/10.1016/j.eurox.2023.100228.
Fu B., Qin N., Cheng L., Tang G., Cao Y., Yan C. et al. Development and validation of an Infertility Stigma Scale for Chinese women. J. Psychosom. Res. 2015; 79(1): 69-75. https://dx.doi.org/10.1016/j.jpsychores.2014.11.014.
Ledermann K., von Känel R., Wagner J. A psychosomatic perspective on endometriosis – a mini review. Cortica. 2023; 2(1):197-214.https://dx.doi.org/10.5167/uzh-255511.
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. https://dx.doi.org/10.1016/j.fertnstert.2017.07.016.
Estes S.J., Huisingh C.E., Chiuve S.E., Petruski-Ivleva N., Missmer S.A. Depression, anxiety, and self-directed violence in women with endometriosis: a retrospective matched-cohort study. Am. J. Epidemiol. 2021; 190(5): 843-52. https://dx.doi.org/10.1093/aje/kwaa249.
Saccone G., Khalifeh A., Elimian A., Bahrami E., Chaman-Ara K., Bahrami M.A. et al. Vaginal progesterone vs intramuscular 17α-hydroxyprogesterone caproate for prevention of recurrent spontaneous preterm birth in singleton gestations: systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet. Gynecol. 2017; 49(3): 315-21. https://dx.doi.org/10.1002/uog.17245.
González-Echevarría A.M., Rosario E., Acevedo S., Flores I. Impact of coping strategies on quality of life of adolescents and young women with endometriosis. J. Psychosom. Obstet. Gynaecol. 2019; 40(2): 138-45. https://dx.doi.org/10.1080/0167482X.2018.1450384.
Chandel P.K., Maurya P.K., Hussain S., Vashistha D., Sharma S. Endometriosis and depression: a double agony for women. Ann. Neurosci. 2023; 30(3): 205-9. https://dx.doi.org/10.1177/09727531231152022.
Chen L.C., Hsu J.W., Huang K.L., Bai Y.M., Su T.P., Li C.T. et al. Risk of developing major depression and anxiety disorders among women with endometriosis: A longitudinal follow-up study. J. Affect. Disord. 2016; 190: 282-5. https://dx.doi.org/10.1016/j.jad.2015.10.030.
Gao M., Koupil I., Sjöqvist H., Karlsson H., Lalitkumar S., Dalman C. et al. Psychiatric comorbidity among women with endometriosis: nationwide cohort study in Sweden. Am. J. Obstet. Gynecol. 2020; 223(3): 415.e1-415.e16. https://dx.doi.org/10.1016/j.ajog.2020.02.033.
Meints S.M., Edwards R.R. Evaluating psychosocial contributions to chronic pain outcomes. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2018; 87(Pt B): 168-82. https://dx.doi.org/10.1016/j.pnpbp. 2018.01.017.
Оразов М.Р., Радзинский В.Е., Михалева Л.М., Хамошина М.Б., Бекулова М.А. Диспареуния как визитная карточка инфильтративных форм эндометриоза. Трудный пациент. 2021; 19(1): 18-22. [Orazov M.R., Radzinsky V.E., Mikhaleva L.M., Khamoshina M.B., Bekulova M.A. Dyspareunia as a hallmark of infiltrative forms of endometriosis. Difficult Patient. 2021; 19(1): 18-22.(in Russian)]. https://dx.doi.org/10.24412/2074-1995-2021-1-18-22.
Barberis N., Cannavò M., Cuzzocrea F., Saladino V., Verrastro V. "Illness perceptions and factors of distress as mediators between trait emotional intelligence and quality of life in endometriosis". Psychol. Health Med. 2023; 28(7): 1818-30. https://dx.doi.org/10.1080/13548506.2023.2175878.
Leventhal H., Phillips L.A., Burns E. The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. J. Behav. Med. 2016; 39(6): 935-46. https://dx.doi.org/10.1007/s10865-016-9782-2.
Secosan C., Balulescu L., Brasoveanu S., Balint O., Pirtea P., Dorin G.et al. Endometriosis in menopause-renewed attention on a controversial disease. Diagnostics (Basel). 2020; 10(3): 134. https://dx.doi.org/10.3390/diagnostics10030134.
Cole J.M., Grogan S., Turley E. “The most lonely condition I can imagine”: Psychosocial impacts of endometriosis on women’s identity. Feminism & Psychology. 2021; 31(2): 171-91. https://dx.doi.org/10.1177/0959353520930602.
Münch F., Ebert A., Mechsner S., Richter R., David M. Subjective theories of illness in fibroid and endometriosis patients: Similarities, differences, and influencing factors. Journal of Endometriosis and Pelvic Pain Disorders. 2022; 14(2): 71-9. https://dx.doi.org/10.1177/22840265211073017.

Received 01.08.2024

Accepted 07.11.2024

Ioanna J. Managadze, Student, N.V. Sklifosovsky ICM, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University),
119991, Russia, Moscow, Trubetskaya str., 8, bld. 2, +7(495)609-14-00, ktb1966@mail.ru, https://orcid.org/0000-0001-8745-9372
Angelina A. Nesterova, PhD student at the Department of Obstetrics and Gynecology, N.V. Sklifosovsky ICM, I.M. Sechenov First Moscow State Medical University,
Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8, bld. 2, +7(495)609-14-00, angelina.aleksashina@mail.ru,
https://orcid.org/0009-0004-1913-5703
Oxana S. Levakova, PhD, Head of the Department of Geriatrics and Psychosomatic Disorders, Clinical Hospital No. 85 of the Federal Medical-Biological Agency of Russia, 115409, Russia, Moscow, Moskvorech’e str., 16, +7(499)782-85-85, oksana.matveeva1910@yandex.ru
Sergey A. Levakov, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, N.V. Sklifosovsky ICM, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8, bld. 2, +7(495)609-14-00, levakoff@yandex.ru,
https://orcid.org/0000-0002-4591-838X
Corresponding author: Ioanna J. Managadze, ktb1966@mail.ru

Psychoemotional aspects and somatic status of women with endometriosis: is there a link?

Managadze I.D., Nesterova A.A., Levakova O.S., Levakov S.A.

Keywords

References

About the Authors

Similar Articles