Educational and occupational outcomes during early adulthood following surgically verified endometriosis at a young age—A register-based study

Introduction

Endometriosis is associated with educational and occupational challenges, including absenteeism and reduced capacity to study and work. We aimed to investigate long-term educational and occupational outcomes among women diagnosed with endometriosis at a young age. We also assessed whether depression, anxiety, and pain affected these outcomes.

Material and Methods

We conducted a historical, register-based cohort study of 4532 women diagnosed surgically with endometriosis before age 25 between 1987 and 2012, identified from the Finnish Hospital Discharge Register. Data on education, socioeconomic status, and occupation were available until 2019. We compared outcomes across age groups (25, 26–30, 31–35, and 36–40) between women with endometriosis and references (N = 9014), and within the endometriosis cohort by subtype and mental health status. Categorical and continuous variables were analyzed using Pearson's chi-squared and Wilcoxon tests. Occupational attainments were examined using multinomial logistic regression to assess odds ratios (OR) and mediation analysis to assess the contribution of parity, depression, anxiety, and pain.

Results

Median age at diagnosis was 22.9 years (interquartile range 21.3–24.1). Follow-up data were available at ages 26 (n = 13 323, 98.4%), 31 (n = 12 465, 92.0%), and 36 (n = 10 293, 76.0%). Across all ages, women with endometriosis more often had primary or secondary education and were employed in lower-level positions (p < 0.001). Ovarian-only endometriosis was associated with a higher likelihood of tertiary education by ages 31–40 (p < 0.001). Women with endometriosis and preindex depression or anxiety had lower education at younger ages and were more often students or pensioners from age 26 onward (p < 0.001). In multinomial regression, women with endometriosis appeared to attain their highest occupational statuses earlier but at a lower level than matched references. Compared to blue-collar workers, they had lower crude odds of being managers and professionals (OR 0.88, 95% CI [0.81–0.96]). But this association reversed when pain was included in the model (OR 1.15, [1.04–1.28]). Depression/anxiety and pain significantly appeared to be mediating factors via suppressing occupational advancement.

Conclusions

Endometriosis diagnosed at a young age is associated with lower educational and occupational attainment, highlighting the long-term socioeconomic impacts. Painful subtypes and preexisting depression or anxiety were associated with poorer outcomes.