Department of Public Health, University of Oxford, Oxford, UK.
Fertil Steril. 2011 Aug;96(2):366-373.e8. doi: 10.1016/j.fertnstert.2011.05.090. Epub 2011 Jun 30.
To assess the impact of endometriosis on health-related quality of life (HRQoL) and work productivity.
Multicenter cross-sectional study with prospective recruitment.
Sixteen clinical centers in ten countries.
PATIENT(S): A total of 1,418 premenopausal women, aged 18-45 years, without a previous surgical diagnosis of endometriosis, having laparoscopy to investigate symptoms or to be sterilized.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Diagnostic delay, HRQoL, and work productivity.
RESULT(S): There was a delay of 6.7 years, principally in primary care, between onset of symptoms and a surgical diagnosis of endometriosis, which was longer in centers where women received predominantly state-funded health care (8.3 vs. 5.5 years). Delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia, and heavy periods) and a higher body mass index. Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis. Each affected woman lost on average 10.8 hours (SD 12.2) of work weekly, mainly owing to reduced effectiveness while working. Loss of work productivity translated into significant costs per woman/week, from US$4 in Nigeria to US$456 in Italy.
CONCLUSION(S): Endometriosis impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity.
评估子宫内膜异位症对健康相关生活质量(HRQoL)和工作生产力的影响。
前瞻性招募的多中心横断面研究。
十个国家的 16 个临床中心。
共 1418 名 18-45 岁的绝经前妇女,无先前的子宫内膜异位症手术诊断,因腹腔镜检查症状或绝育而就诊。
无。
诊断延迟、HRQoL 和工作生产力。
从症状出现到手术诊断子宫内膜异位症,主要在初级保健中存在 6.7 年的延迟,在妇女主要接受国家资助的卫生保健的中心,该延迟时间更长(8.3 年比 5.5 年)。延迟与盆腔症状的数量呈正相关(慢性盆腔痛、痛经、性交困难和经量过多)和更高的体重指数。与具有相似症状但无子宫内膜异位症的妇女相比,受影响的妇女的身体 HRQoL 显著降低。每位受影响的妇女平均每周损失 10.8 小时(SD 12.2)的工作时间,主要是由于工作效率降低。生产力损失导致每位妇女/周的费用显著增加,从尼日利亚的 4 美元到意大利的 456 美元不等。
子宫内膜异位症在全球和不同种族中都损害了 HRQoL 和工作生产力,但女性在初级保健中仍经历着诊断延迟。需要提高对有症状女性的专科评估的怀疑指数。未来的研究应致力于阐明与子宫内膜异位症严重程度相关的疼痛机制。