Study suggests prevalence of fatigue more than doubled in women diagnosed with endometriosis
Fatigue is a common but underestimated symptom of endometriosis, according to findings from an international study of over 1100 women.
The study found that the prevalence of fatigue more than doubled in women diagnosed with endometriosis. It remained significant after the results were adjusted for other factors that might play a role in fatigue, such as pain, insomnia, occupational stress, depression, BMI and motherhood.  The study was published today in Human Reproduction, one of the world’s leading reproductive medicine journals.
“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,” said Professor Brigitte Leeners, deputy head of the Department of Reproductive Endocrinology at the University Hospital Zurich, Switzerland, who led the research.
Reliable data about its incidence is hard to come by. Some estimates suggest 25 to 50% of infertile women have endometriosis and 30-50% of women with endometriosis are infertile
Endometriosis is a condition in which the tissues lining the cell of the uterus starts growing outside it – sometimes in the ovaries, fallopian tubes and the pelvic lining. It is often painful. Reliable data about its incidence is hard to come by. Some estimates suggest 25 to 50% of infertile women have endometriosis and 30-50% of women with endometriosis are infertile.
“Although chronic fatigue is known to be one of the most debilitating symptoms of endometriosis, it is not widely discussed and few large studies have investigated it. 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. It would also help these women if steps were taken to reduce insomnia, pain, depression and occupational stress,” Leeners said.
The researchers recruited 1120 women, 560 with endometriosis matched with 560 without it, from hospitals and private practices in Switzerland, Germany and Austria between 2010 and 2016. The women completed a questionnaire that asked about various factors relating to quality of life and endometriosis, as well as medical and family histories, life style and mental disorders. Fatigue and insomnia were categorised into five different levels ranging from 1 (never) to 5 (very often).
They found that 50.7% of women diagnosed with endometriosis suffered from frequent fatigue compared to 22.4% of women without the condition. Fatigue with endometriosis was also associated with a more than seven-fold increase in insomnia, a four-fold increase in depression, a two-fold increase in pain and a nearly 1.5-fold increase in occupational stress. Age, time since first diagnosis and the stage of the disease were not linked to fatigue.
The researchers say that a possible reason why endometriosis could cause fatigue, independently of the other factors, is that the endometrial lesions may be causing inflammation that activates the immune system. Proteins called cytokines that are involved in cell signalling when the immune system is activated have been shown to play a role in fatigue symptoms. Chronic exposure to high stress can result in adrenal fatigue, and this could be an additional possible explanation.
