Mousa Mira, Al-Jefout Moamar, Alsafar Habiba, Becker Christian M, Zondervan Krina T, Rahmioglu Nilufer
Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom.
Department of Obstetrics and Gynaecology, College of Medical and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
Front Glob Womens Health. 2021 Sep 14;2:708410. doi: 10.3389/fgwh.2021.708410. eCollection 2021.
Endometriosis has a negative effect on health-related quality of life (HRQoL), wellbeing and daily functioning. Endometriosis is an under-researched condition within non-western populations. Cultural representations are needed to understand the relative roles of societal norms, traditional factors, and religious sensitivities on the impact of endometriosis on HRQoL in various populations. In particular, there is a lack of emphasis placed in understanding the association of HRQoL on endometriosis in Arab women. In this prospective case-control study, 2,610 Arab ancestry women in the United Arab Emirates were recruited to investigate the impact of endometriosis on HRQoL, diagnostic delay, psychological co-morbidities, work productivity, and physical activity. Participants completed the following standardized, validated questionnaires: Short Form-36 version 2 questionnaire, the World Endometriosis Research Foundation EPHect minimum clinical questionnaire version, and Work Productivity and Activity Impairment questionnaire. Translations to the Arabic language, validated using the forward-backward translation method, of the questionnaires were utilized. HRQoL scores were significantly impaired in women with endometriosis, as demonstrated in the Physical Composite Scores and Mental Composite Scores in the symptomatic control group ( = 0.001; = 0.003, respectively) and the asymptomatic control group ( < 0.001; < 0.001, respectively). Susceptibility and severity of multiple pain syndromes and infertility in women with endometriosis was the main indicator of lower HRQoL. Anxiety ( = 0.007) and depression ( = 0.005) were significantly associated with endometriosis, in comparison to symptomatic controls. The average diagnostic delay was 11.61 years, however single women experience 15.81 years of diagnosis delay, with approximately 18% ( = 15) of the single women experiencing more than a 20-year delay in diagnosis. The intensity of physical activity was not associated with endometriosis, when compared to symptomatic ( = 0.405) or asymptomatic controls ( = 0.144). For the first time, we provide evidence from a combined hospital, clinic, and population-based study that Arab women with endometriosis experience significant impacts on HRQoL, substantial diagnostic delay after the onset of symptoms, significant association to psychological disorders (anxiety and depression), and a negative impact on work productivity. Future research must focus on understanding the personal and culturally centered beliefs of Arab women to ensure a positive HRQoL trajectory by improving diagnosis and management strategies.
子宫内膜异位症对健康相关生活质量（HRQoL）、幸福感和日常功能有负面影响。子宫内膜异位症在非西方人群中是一种研究不足的病症。需要通过文化表征来理解社会规范、传统因素和宗教敏感性在不同人群中对子宫内膜异位症对HRQoL影响的相对作用。特别是，在理解阿拉伯女性中HRQoL与子宫内膜异位症的关联方面缺乏足够的重视。在这项前瞻性病例对照研究中，招募了阿拉伯联合酋长国的2610名阿拉伯裔女性，以调查子宫内膜异位症对HRQoL、诊断延迟、心理共病、工作效率和身体活动的影响。参与者完成了以下标准化、经过验证的问卷：简短健康调查问卷第2版、世界子宫内膜异位症研究基金会EPHect最低临床问卷版以及工作效率和活动障碍问卷。使用向前-向后翻译法验证的问卷阿拉伯语译本被采用。有子宫内膜异位症的女性的HRQoL得分显著受损，有症状对照组（分别为 = 0.001； = 0.003）和无症状对照组（分别为 < 0.001； < 0.001）的身体综合得分和心理综合得分都证明了这一点。子宫内膜异位症女性中多种疼痛综合征和不孕症的易感性和严重程度是HRQoL较低的主要指标。与有症状对照组相比，焦虑（ = 0.007）和抑郁（ = 0.005）与子宫内膜异位症显著相关。平均诊断延迟为11.61年，然而单身女性的诊断延迟为15.81年，约18%（ = 15）的单身女性诊断延迟超过20年。与有症状对照组（ = 0.405）或无症状对照组（ = 0.144）相比，身体活动强度与子宫内膜异位症无关。我们首次从一项综合医院、诊所和基于人群的研究中提供证据，表明患有子宫内膜异位症的阿拉伯女性的HRQoL受到重大影响，症状出现后诊断有实质性延迟，与心理障碍（焦虑和抑郁）有显著关联，并且对工作效率有负面影响。未来的研究必须专注于理解阿拉伯女性以个人和文化为中心的信念，通过改进诊断和管理策略来确保积极的HRQoL轨迹。
