International Journal of Reproductive BioMedicine

Published date: Apr 26 2025

Journal Title: International Journal of Reproductive BioMedicine

Issue title: International Journal of Reproductive BioMedicine (IJRM): Volume 23, Issue No. 2

Pages: 199 – 206

DOI: 10.18502/ijrm.v23i2.18494

Mania KavehDepartment of Obstetrics and Gynecology, School of Medicine, Amir Al Momenin Hospital, Zabol University of Medical Sciences, Zabol

Haniye MalakoutiSchool of Medicine, Zabol University of Medical Sciences, Zabol

Shahla ChaichianEndometriosis Research Center, Iran University of Medical Sciences, Tehran

Abolfazl Mehdizadeh KashiIranian Scientific Society of Minimally Invasive Gynecology, Tehran

Mahdi AfshariDepartment of Community Medicine, School of Medicine, Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol

Kambiz SadegiKamsadegi@yahoo.co.ukDepartment of Anesthesiology, School of Medicine, Amir Al Momenin Hospital, Zabol University of Medical Sciences, Zabol

Background: Studies have shown that endometriosis significantly has a negative impact on women’s mental health and quality of life (QoL), resulting in these participants experiencing a diminished QoL.

Objective: This study aimed to evaluate the effect of laparoscopic surgery on the severity of pain and the QoL of women with different types of endometriosis.

Materials and Methods: In this follow-up study 50 women with endometriosis, who underwent laparoscopic surgery, who met a high visual analog score (> 6) with impaired QoL, lack of response to analgesics, infertility with pain unresponsive to assisted reproductive therapy, and involvement of other organs such as the bowel or ureter at the Amir Al Momenin hospital, Zabol, Iran, from August 2022 to January 2023 were enrolled. The participants were categorized into 2 groups: those with stage IV endometriosis and those with lower stages (I-III). Groups according to the higher occurrence of grade 4 endometriosis, as 55.1% were affected by it. The pain score was measured using the visual analog score, and the participants’ QoL score was measured using the endometriosis health profile questionnaire.

Results: The mean age of participants was 32 yr, with a standard deviation of 8.6 yr. Participants were divided into 2 groups: those with grade 4 endometriosis (55.1%) and those with a grade lower than 4, as classified by the American Society for Reproductive Medicine. Over 12 months, both groups experienced a significant decrease in pain severity and QoL scores (p < 0.0001). However, the changes in pain and QoL scores between the 2 groups were not statistically significant (p = 0.520 and p = 0.984, respectively).

Conclusion: Laparoscopic treatment can reduce pain and QoL scores (increase the QoL indices) in women with endometriosis, regardless of the disease’s severity.

Keywords: Endometriosis, Laparoscopy, Pain, Quality of Life

[1] Farland LV, Shah DK, Kvaskoff M, Zondervan KT, Missmer SA. Epidemiological and clinical risk factors for endometriosis. In: D’Hooghe T. Biomarkers for endometriosis: state of the art. Cham: Springer; 2017: 95–121.

[2] Xu B, Guo N, Zhang X-M, Shi W, Tong X-H, Iqbal F, et al. Oocyte quality is decreased in women with minimal or mild endometriosis. Sci Rep 2015; 5: 10779.

[3] Sourial S, Tempest N, Hapangama DK. Theories on the pathogenesis of endometriosis. Iran J Reprod Med 2014; 2014: 179515.

[4] Eisenberg VH, Weil C, Chodick G, Shalev V. Epidemiology of endometriosis: A large population-based database study from a healthcare provider with 2 million members. BJOG 2018; 125: 55–62.

[5] Melis I, Litta P, Nappi L, Agus M, Melis GB, Angioni S. Sexual function in women with deep endometriosis: Correlation with quality of life, intensity of pain, depression, anxiety, and body image. Int J Sex Health 2015; 27: 175–185.

[6] Brosens I, Gargett CE, Guo S-W, Puttemans P, Gordts S, Brosens JJ, et al. Origins and progression of adolescent endometriosis. Reprod Sci 2016; 23: 1282–1288.

[7] Lee S-Y, Koo Y-J, Lee D-H. Classification of endometriosis. Yeungnam Univ J Med 2021; 38: 10–18.

[8] Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep 2017; 6: 34–41.

[9] Chauhan S, More A, Chauhan V, Kathane A. Endometriosis: A review of clinical diagnosis, treatment, and pathogenesis. Cureus 2022; 14: e28864.

[10] Bafort C, Beebeejaun Y, Tomassetti C, Bosteels J, Duffy JM. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev 2020; 10: CD011031.

[11] Khine YM, Taniguchi F, Harada T. Clinical management of endometriosis-associated infertility. Reprod Med Biol 2016; 15: 217–225.

[12] Waldman SD. Pain management. 2nd Ed. USA: Saunders; 2011.

[13] Nojomi M, Bijari B, Akhbari R, Kashanian M. The assessment of reliability and validity of Persian version of the endometriosis health profile (EHP-30). Iran J Med Sci 2011; 36: 84–89.

[14] Abbott J, Billow M, Gallant T, Hackett L, Kho RM, Knapman B, et al. Patient-reported outcome measures used in randomized controlled trials following surgical intervention for endometriosis: A structured review from the AAGL practice guidelines group. J Minim Invasive Gynecol 2024; 31: 71–83.

[15] Farzianpour F, Shojaei S, Arab M, Foroushani AR. Accreditation of management communication and information systems in public hospitals of Sabzevar City, Iran. Acta Inform Med 2016; 24: 124–129.

[16] Ellis K, Munro D, Clarke J. Endometriosis is undervalued: A call to action. Front Glob Womens Health 2022; 3: 902371.

[17] Parra RS, Feitosa MR, Camargo HP, Valério FP, Zanardi JVC, Rocha JJR, et al. The impact of laparoscopic surgery on the symptoms and wellbeing of patients with deep infiltrating endometriosis and bowel involvement. J Psychosom Obstet Gynaecol 2021; 42: 75–80.

[18] Darici E, Kemahlı MNC, Bahat PY, Yücel B, Oral E. Validation of the Turkish version of endometriosis health profile questionnaire (EHP-30) to evaluate the quality of life in women with endometriosis. Facts Views Vis Obgyn 2023; 15: 131–136.

[19] Bastu E, Celik HG, Kocyigit Y, Yozgatli D, Yasa C, Ozaltin S, et al. Improvement in quality of life and pain scores after laparoscopic management of deep endometriosis: A retrospective cohort study. Arch Gynaecol Obstet 2020; 302: 165–172.

[20] Comptour A, Chauvet P, Canis M, Grémeau A-S, Pouly J-L, Rabischong B, et al. Patient quality of life and symptoms after surgical treatment for endometriosis. J Minim Invasive Gynecol 2019; 26: 717–726.

[21] Angioni S, Pontis A, Dessole M, Surico D, De Cicco Nardone C, Melis I. Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRHa administration after surgery. Arch Gynaecol Obstet 2015; 291: 363–370.

[22] Laguerre MD, Arkerson BJ, Robinson MA, Moawad NS. Outcomes of laparoscopic management of chronic pelvic pain and endometriosis. J Obstet Gynaecol 2022; 42: 146–152.

[23] Rindos NB, Fulcher IR, Donnellan NM. Pain and quality of life after laparoscopic excision of endometriosis. J Minim Invasive Gynecol 2020; 27: 1610–1617. e1.