The Association between Pathology Confirmed Versus Unconfirmed Endometriosis and Anxiety and Depression

Abstract

Study Objective

Among patients with endometriosis, disease symptoms associate poorly with lesion burden, and severe symptoms of endometriosis can occur in patients in whom lesions cannot be detected by pathologic examination. Anxiety and depression are prevalent in patients with confirmed endometriosis. This study aimed to examine these comorbid traits in patients with endometriosis-like symptoms in the absence of a confirmed diagnosis.

Design

A prospective study. We collected data from patients who underwent surgery for endometriosis and controls who underwent surgery for other indications between 10/2019 and 3/2024, as part of The Biologic and Epidemiologic Markers of Endometriosis (BEME) clinic-based study.

Setting

Quaternary level hospital.

Patients or Participants

We compared patients with pathology confirmed endometriosis to patients with suspected endometriosis and negative pathology (SENP) and controls.

Interventions

Multivariable regressions analysis to evaluate the association between pathology confirmed endometriosis and medically treated anxiety and/or depression.

Measurements and Primary Results

454 women were included in the study, of which 308 (67.8%) had pathology confirmed endometriosis, 45 (9.9%) had SENP, and 101 (22.2%) were controls without endometriosis. The proportion of depression among patients with pathology confirmed endometriosis, SENP and controls 42.4%, 60.0% and 40.6%, respectively. The proportion of anxiety among the groups was 52.9%, 60.0% and 46.5%, respectively. In multivariable regression analysis, compared to patients with pathology confirmed endometriosis, depression was independently associated with patients with SENP (aOR 2.30 95%CI 1.03-5.17). Anxiety alone or the combination of anxiety and/or depression were not independently associated with any of the study groups.

Conclusion

Patients with pain symptoms indicative of endometriosis and negative pathology have increased risk of depression, and comparable risk of anxiety compared to patients with pathology confirmed endometriosis. Long-term follow-up of SENP patients will be valuable to determine outcomes for this group of patients, and to optimize the best strategies for clinical care.