Endometriosi e qualità di vita: fattori clinici associati alla salute psicofisica delle donne

Endometriosis, caused by the progressive growth of uterine mucosa tissue in abnormal locations, either within the uterine muscle wall (internal endometriosis) or in other organs, significantly impacts daily life, family and work activities, sexual health, and interpersonal relationships, inducing a chronic inflammatory state and persistent suffering. Clinically, it manifests with debilitating symptoms, particularly chronic pelvic pain, severe dysmenorrhea, dyspareunia, and, in many cases, bowel and urinary disorders. This pain, sometimes cyclical but often constant, is influenced by inflammation and deep infiltration of lesions into surrounding tissues, contributing to central sensitization that persists even after surgical removal of the lesions. Three main phenotypes are recognized: superficial peritoneal lesions, ovarian endometriomas, and deep infiltrating endometriosis. Diagnosis is made through imaging and laparoscopy, while treatment ranges from medical to surgical approaches, with increasingly personalized options aimed at maintaining a good quality of life for patients. The persistence of painful symptoms in endometriosis plays a key role in compromising the physical and psychological well-being of patients, negatively affecting their work, relationships, and family life. The aim of this study, described in the third chapter, is to provide a realistic understanding of the experiences related to endometriosis and to delve into the dimensions most involved in the impairment of quality of life. Factors considered, such as depression, anxiety, post-traumatic symptoms, catastrophic thinking, dysmenorrhea, chronic pelvic pain, dyspareunia, along with other painful symptoms such as dysuria and dyschezia, are likely determinants of the deterioration in quality of life in women with endometriosis. The research involved 234 patients diagnosed with endometriosis, followed at the Endometriosis Clinic of the Città della Salute e della Scienza di Torino, Sant'Anna Hospital, between October 2023 and June 2024. Assessments were conducted using five self-administered questionnaires measuring the level of perceived pain. The results show a significant impairment in several areas, including pain, sense of control, emotional well-being, social support, and self-perception, with average scores above 30%, indicating a marked deterioration in quality of life related to endometriosis. It is highlighted that chronic pelvic pain, frequently manifesting even outside the menstrual cycle, is strongly correlated with symptoms such as dysuria, dyspareunia, and depression, with a significant impact on the patients' sexual and relational quality of life. Psychologically, many women with endometriosis show a high incidence of anxiety and depression, confirming the close relationship between painful symptoms and the development of psychiatric disorders. The tendency to catastrophize pain, reducing the perceived control over the symptom, has severe consequences on emotional well-being and social functioning. Additionally, symptoms of post-traumatic stress, often related to past traumatic experiences such as abuse or emotional neglect, are common. Regression analysis clarifies that the quality of life of women with endometriosis is profoundly influenced by painful symptoms, particularly chronic pelvic pain and the catastrophization of pain, with significant repercussions on emotional well-being and social dynamics. It also clearly emerges that social support plays a fundamental role in countering feelings of isolation and enhancing self-efficacy, while dysuria and post-traumatic stress symptoms prove to be determining factors for self-image, thus highlighting the complexity of the interactions between physical and psychological factors in the context of endometriosis. Equally noteworthy is the lack of an appreciable cause-effect relationship between depression and quality of life in all five representative areas of the Endometriosis Health Profile.

L'endometriosi, caratterizzata dalla crescita anomala di tessuto endometriale in sedi extra-uterine, provoca dolore cronico, dismenorrea, dispareunia e disturbi intestinali e urinari, compromettendo la qualità della vita delle pazienti. Lo studio condotto in questa sede ha analizzato 234 pazienti presso l'Ospedale Sant'Anna di Torino (2023-2024) tramite questionari, evidenziando un impatto significativo su benessere emotivo, relazioni sociali e percezione di sé. Il dolore pelvico cronico, presente anche al di fuori del ciclo mestruale, è strettamente correlato con ansia, depressione e sintomi come disuria. La catastrofizzazione del dolore e la sensibilizzazione centrale risultano determinanti, aggravando il malessere psicologico e fisico. Il supporto sociale emerge come fattore protettivo, contrastando l'isolamento e migliorando l'autoefficacia, mentre non è stata trovata una chiara relazione causa-effetto tra depressione e qualità della vita associata alle cinque aree dell' Endometriosis Health Profile. I sintomi dolorosi, ansiosi e la catastrofizzazione del dolore rimangano i principali responsabili del deterioramento del benessere complessivo.