Analysis of the influence of endometriosis on quality of life

Introduction: Endometriosis is a disorder that can significantly affect quality of life (QOL) and interfere in biological, psychological, social, marital and family aspects. Objective: To analyze the influence of endometriosis on the QOL of women diagnosed with the disease. Methods: The study was carried out from March to April 2018, with 10 volunteers from the Santa Casa de Misericórdia do Pará Foundation, with a clinical diagnosis of endometriosis. The Portuguese version of the endometriosis health profile questionnaire (EHP-30) was applied in order to assess QOL in women with this pathology. Results: The sociodemographic results revealed a predominance of women aged between 29 and 55 years, most of whom were married (6) and high school graduates (5). Seven of the ten volunteers had previous pregnancies. Of the aspects evaluated in the EHP-30, 79% of the items associated with pelvic pain in the core questionnaire were present in the participants. In other questionnaires, sexual life (82%) was the most affected index, followed by professional life (70%) and infertility (58.82%). Conclusion: The aspects of QOL most impacted by pelvic pain associated with endometriosis in the women evaluated were sexuality and professional life, leading to biopsychosocial trauma.


Introduction
Endometriosis (EDM) is a chronic inflammatory pathology characterized by the growth of tissue histologically similar to the endometrium outside the uterine cavity, which typically affects organs in the peritoneum or pelvis, such as the ovaries and rectovaginal septum. It is one of the most frequent pelvic disorders with no defined etiology. 1 While its prevalence is still unknown, 2 to 10% of women of childbearing age may be affected by EDM and 50% of women who have chronic pelvic pain (CPP) may be diagnosed with the disorder. 2 It is estimated that 10% of women of reproductive age, 30 to 50% of infertile women and 3 to 5% of postmenopausal women may be diagnosed with EDM. 3 Symptoms of the disease are variable and nonspecific, mostly associated with dysmenorrhea, dyspareunia, CPP, infertility, and urinary or intestinal disorders, making diagnosis difficult. 4 The main symptoms are: pain and infertility, with some women suffering extreme pain (CPP). 5 It is believed that, in addition to chronic disease, CPP can cause physical, psychological and social damage, negatively impacting the daily life of these women. 6 Concerns regarding QOL have been raised in the fields of human and biological sciences, since there is a need to manage symptoms, reduce mortality and improve life expectancy. 7 According to the World Health  and is transformed into a score ranging from 0 to 100, where zero represents the best QOL and 100 the worst.
A score ranging from 0 to 4 is atributed to each item, where: 0 = never , 1 = rarely, 2 = sometimes, 3 = often and 4 = always. According to Marqui,12 only three studies applied this questionnaire, but compared to the SF -36, which is the most widely used questionnaire to assess quality of life in endometriosis and measure QOL in general, the EHP-30 proved to be more precise and adequate, since it is specific to the pathology in question. 10,[13][14][15] In addition, the present study differs from other investigations by evaluating QOL in women with a proven clinical diagnosis of endometriosis for one year or more, using a specific tool to assess the disease.

Statistical analysis
After research was carried out, data from the questionnaires, extracted from the assessments and tabulated in an Excel spreadsheet, were compared. Next, for data analysis, the IBM SPSS program (Statistical Package for the Social Sciences) was used, where test selection for statistical analysis depended on the types of distributions found and data homogeneity of the respective variances.
The Kolmogorov-Smirnov test was used to assess normality, and the Spearman's nonparametric statistical test for data comparison. The level of rejection of the null hypothesis was set at 0.05 or 5%.

Results
Ten volunteers aged between 29 and 55 years were selected, most of whom were in a committed relationship.
Two criteria were used for demographic data analysis: schooling level and marital status. Five of the women have a high school diploma, six are married and seven had previous pregnancies.
The data exhibited in Table 1, obtained from the EHP-30 questionnaire, show that the daily tasks of approximately 39% of the women were compromised due to pelvic pain, over 40% had to give up some of their daily activities at some point and only 20% never had to stop performing their tasks due to pain.
The professional activities of most volunteers with endometriosis (70% according to the EHP-30 questionnaire) were compromised due to pelvic pain.
Only 30% of participants reported never experiencing work problems due to endometriosis-related pelvic pain, 4% rarely suffered from this issue, 12% reported occasional difficulties, 6% often had their work routine compromised and 48% indicated that this type of pain has always interfered with professional activity.
With regard to urinary symptoms (    In relation to pelvic congestion syndrome (

Conclusion
With respect to the results obtained from the EHP-30 questionnaire , it was found that the quality of life of women diagnosed with endometriosis was compromised by pelvic pain, which affects both their professional and sexual life, with consequent psychological, physical and social impacts. Since the present study was based on a small sample size, it is not possible to extrapolate the results obtained to the reality of all women affected by endometriosis.
In light of the above, it is suggested that further research be carried out with a larger number of endometriosis patients whose primary symptom is pelvic pain in order to better clarify the impacts of this disease and establish treatment consistent with the main complaints, in an effort to promote quality of life and a holistic health intervention.

Authors' contribution
LAR, SAA, GNF recruited individuals and conducted interviews. LAR analyzed the data and wrote the manuscript with contributions from all co-authors.
EFCN developed the study design, PESA supervised the study, and both contributed to the critical revision of the manuscript. All authors read and approved the final manuscript.