Anxiety and depression in patients with endometriosis: impact and management challenges

Abstract

Endometriosis is one of the most common gynecological diseases and affects ~10% of women in reproductive age. The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain (CPP), dysmenorrhea, dyspareunia and infertility. Symptoms of endometriosis often affect psychological and social functioning of patients. For this reason, endometriosis is considered as a disabling condition that may significantly compromise social relationships, sexuality and mental health. Considering this point, the aim of this narrative review is to elucidate the impact of anxiety and depression in the management of women with endometriosis. Psychological factors have an important role in determining the severity of symptoms, and women who suffer from endometriosis report high levels of anxiety, depression and other psychiatric disorders. In addition, endometriosis is one of the most important causes of CPP; women with endometriosis suffer from a wide range of pelvic pain such as dysmenorrhea, dyspareunia, nonmenstrual (chronic) pelvic pain, pain at ovulation, dyschezia and dysuria. Several studies have underlined the influence of CPP on quality of life and psychological well-being of women with endometriosis. Data suggest that the experience of pelvic pain is an important component of endometriosis and may significantly affect emotive functioning of affected women. It has been demonstrated that high levels of anxiety and depression can amplify the severity of pain. Further studies are needed to better understand the relationship between psychological factors and perception of pain. Treatment of endometriosis may be hormonal or surgical. Surgery is the primary treatment for more severe forms of endometriosis. There are few data in the literature about the influence of psychological factors and psychiatric comorbidities on the effectiveness of treatments. It is important to evaluate the presence of previous psychiatric diseases in order to select the most appropriate treatment for the patient.

Effect of Mst1 on Endometriosis Apoptosis and Migration: Role of Drp1-Related Mitochondrial Fission and Parkin-Required Mitophagy

“…It is an inflammatory and estrogen-dependent disease that affects 6-10% of women during their reproductive years and up to 50% of women receiving fertility treatments [1,2]. The endometrium is comprised of stromal cells and epithelial compartments.…”

Disclosing the invisible: experiences, outcomes and quality of endometriosis healthcare

“…In addition to lower HRQoL, women with PPP in this thesis also had more symptoms of anxiety and depression compared with healthy controls (study III), which is in agreement with earlier research [108,119]. Following the pain-focused hypothesis, the literature suggests that the prevalence of symptoms of depression and anxiety are related to PPP rather than to endometriosis itself [108,113,119].…”

“…The women in this thesis described pain as a central feature of life (study I), an experience also recognized in the literature [5,108,109]. The medical and surgical treatment of endometriosis aims mainly at providing pain control, and secondarily at limiting the progression of the disease and at preserving fertility.…”

Anxiety-depressive disorders of patients with external genital endometriosis

“…В настоящее время замечено, что жен-щины с эндометриозом имеют тревожно-депрессивные и другие психические рас-стройства [8]. Однако до сих пор неясно, тревожно-депрессивное состояние -осо-бенность пациенток с данной патологией или следствие клинических симптомов, та-ких как хроническая тазовая боль [9].…”