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Fatigue: A Crucial Symptom of Endometriosis

ENDOMETRIOSIS can present with a wide variety of symptoms, with pain and infertility being the most commonly reported. However, the results of a new study in >1,100 women suggest that fatigue is a more prevalent and burdensome symptom than previously recognised.

In their study, researchers from the Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland enrolled 1,120 women, half of whom had endometriosis, from private practices in Switzerland, Austria, and Germany between 2010 and 2016. The women answered a questionnaire that featured questions related to endometriosis, quality of life, and their medical and family history.

The results showed that 50.7% of the endometriosis group reported frequent fatigue compared to 22.4% of women in the control group, and this figure remained significant after adjustment for confounding factors such as pain, BMI, and depression. Fatigue with endometriosis was associated with a variety of other conditions: a >7-fold increase in insomnia, a 4-fold increase in depression, a doubling in pain, and a 50% increase in occupational stress. Notably, fatigue was not linked to age, time since first diagnosis, or the stage of the patient’s disease.

“These findings suggest that endometriosis has an effect on fatigue that is independent of other factors and that cannot be attributed to symptoms of the disease”, explained Prof Brigitte Leeners, University Hospital Zurich.

The researchers theorised that endometriosis may result in fatigue via endometrial lesions causing inflammation; the resultant cytokine response to this inflammation has been previously linked to fatigue symptoms. Another possible explanation is the chronic exposure to high stress associated with endometriosis, which can lead to adrenal fatigue.

This study was limited by the subjectivity of the questionnaire, the inherent bias of patients being asked to recall 6-month-old experiences, and the lack of information regarding medication being taken by these patients during the study period. Nonetheless, researchers hope these data will encourage clinicians to examine fatigue more closely in these patients. “We believe that in order to improve the quality of life for women with this condition, investigating and addressing fatigue should become a routine part of medical care, and doctors should investigate and address this problem when they are discussing with their patients the best ways to manage and treat the disease”, concluded Prof Leeners.