Quality of life of women with endometriosis: comparison between epiphenomenon and severe disease

Purpose: To compare pain symptoms and quality of life between epiphenomenon and endometriosis disease. Methods: Between January 2004 and July 2008, 536 new cases of endometriosis confirmed by surgical biopsy were included in this observational cohort study (Auvergne Regional Cohort of Endometriosis). Questionnaires and visual analog scale scores for dysmenorrhoea, dyspareunia, chronic pelvic pain, premenstrual dysuria and dyschesia, quality of life instruments (SF-36), and sexual activity questionnaires were compared between group A (epiphenomenon group: 119 patients) and group B (endometriosis disease group: 318 patients with deep ovarian endometrioma and/or deep infiltrating nodules). Primary outcome was patient-reported pain rates. Secondary outcomes included quality-of-life tools. Results: In cases of severe endometriosis, more pain at defecation and more dysmenorrhoea were observed than in cases of minimal endometriosis. The social repercussions and deterioration in quality of life were also affected, without any distinction between group A and B except for physical limitations. Quality of sex life was also affected in both groups. Conclusions: This study confirms the ubiquitous pain symptoms of endometriosis. The lack of any correlation between functional symptomatology and anatomic severity of disease underlines how important it is not to neglect patients presenting what is called "minimal" endometriosis.