Australian Woman and Girls' Health Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia.
Am J Obstet Gynecol. 2023 Nov;229(5):536.e1-536.e20. doi: 10.1016/j.ajog.2023.07.033. Epub 2023 Jul 25.
Endometriosis has been linked to higher rates of a variety of symptoms; however, the findings from longitudinal studies are scarce and inconsistent.
This study aimed to examine the association between endometriosis and common symptoms in a prospective cohort study.
This study included 7606 women born from 1973 to 1978 using data from the Australian Longitudinal Study on Women's Health that were collected every 3 years from 2009 to 2018. We identified women with endometriosis based on self-reported incidence from each survey and linked administrative health data. At each survey, women also completed a checklist on the presence of 24 symptoms. Generalized estimating equations for multinomial responses were used for analyses.
Women with endometriosis had significantly more menstrual symptoms than those without endometriosis with an adjusted odds ratio (95% confidence interval) of 3.61 (3.11-4.19) for severe period pain, 2.40 (2.10-2.74) for heavy menstrual bleeding, 1.76 (1.52-2.03) for irregular bleeding, and 1.52 (1.32-1.76) for premenstrual tension. They also had higher odds of mental health problems with adjusted odds ratios of 1.67 (1.39-2.01) for depression and 1.59 (1.24-2.03) for anxiety and higher odds of allergies and nonspecific symptoms with adjusted odds of 1.62 (1.40-1.89) for allergies or hay fever or sinusitis, 1.79 (1.56-2.05) for severe tiredness, 1.56 (1.35-1.81) for sleep difficulty, and 1.77 (1.37-2.18) for palpitations. There was also a strong association with other forms of pain with an adjusted odds ratio of 1.76 (1.53-2.04) for backpain, 1.50 (1.29-1.74) for headaches or migraines, and 1.65 (1.41-1.93) for stiff or painful joints. Women with endometriosis also had increased odds of developing bowel and urinary symptoms with an adjusted odds ratio (95% confidence interval) of 1.67 (1.35-2.08) for constipation, 1.46 (1.12-1.90) for hemorrhoids or piles, 1.25 (1.03-1.52) for indigestion or heartburn, 2.80 (1.71-4.58) for urine burn or stings, and 1.37 (1.03-1.82) for vaginal discharge or irritation. The association between each symptom and endometriosis was similar whether endometriosis was surgically confirmed or clinically suspected. No association was found between endometriosis and the risk for skin problems, leaking urine, or breathing difficulty.
This study suggests that women with endometriosis are more likely to report not only menstrual symptoms but are also at an increased risk for mental health problems, other pain symptoms, bowel and urinary symptoms, and nonspecific symptoms, such as severe tiredness and difficulty sleeping.
子宫内膜异位症与多种症状的发生率较高有关；然而，纵向研究的结果却很少且不一致。
本研究旨在通过前瞻性队列研究来研究子宫内膜异位症与常见症状之间的关联。
本研究纳入了来自澳大利亚妇女健康纵向研究的 7606 名 1973 年至 1978 年出生的女性，这些数据来自于 2009 年至 2018 年每 3 年收集一次的调查。我们根据每次调查的自我报告发病率确定了患有子宫内膜异位症的女性，并利用行政健康数据进行了关联。在每次调查中，女性还完成了一份关于 24 种症状存在情况的检查表。采用多变量响应广义估计方程进行分析。
患有子宫内膜异位症的女性比没有子宫内膜异位症的女性更容易出现月经症状，严重经期疼痛的调整后比值比（95%置信区间）为 3.61（3.11-4.19），重度月经过多为 2.40（2.10-2.74），不规则出血为 1.76（1.52-2.03），经前期紧张为 1.52（1.32-1.76）。她们还更有可能出现心理健康问题，调整后的比值比为抑郁 1.67（1.39-2.01），焦虑 1.59（1.24-2.03），过敏和非特异性症状的可能性更高，调整后的比值比为过敏或花粉热或鼻窦炎为 1.62（1.40-1.89），严重疲劳为 1.79（1.56-2.05），睡眠困难为 1.56（1.35-1.81），心悸为 1.77（1.37-2.18）。与其他形式的疼痛也有很强的关联，调整后的比值比为背痛为 1.76（1.53-2.04），头痛或偏头痛为 1.50（1.29-1.74），关节僵硬或疼痛为 1.65（1.41-1.93）。患有子宫内膜异位症的女性还更有可能出现肠道和泌尿系统症状，调整后的比值比（95%置信区间）为便秘为 1.67（1.35-2.08），痔疮或痔核为 1.46（1.12-1.90），消化不良或胃酸反流为 1.25（1.03-1.52），尿液灼伤或刺痛为 2.80（1.71-4.58），阴道分泌物或刺激为 1.37（1.03-1.82）。子宫内膜异位症与每种症状之间的关联在手术确诊或临床疑似的情况下均相似。子宫内膜异位症与皮肤问题、漏尿或呼吸困难的风险之间没有关联。
本研究表明，患有子宫内膜异位症的女性不仅更容易报告月经症状，而且还更容易出现心理健康问题、其他疼痛症状、肠道和泌尿系统症状以及非特异性症状，如严重疲劳和睡眠困难。
