Exploring biopsychosocial health outcomes in endometriosis and endometriosis with co-occurring irritable bowel syndrome - A prospective cohort study.

Objective: To date there has been limited exploration of the impact of endometriosis with co-occurring irritable bowel syndrome (IBS) type symptoms on biopsychosocial health outcomes and wellbeing. This study aimed to prospectively investigate the changes and differences in biopsychosocial factors between individuals with endometriosis (EndoOnly) and individuals with endometriosis and co-occurring IBS-type symptoms (Endo+IBS) over a two-year period.

Methods: 610 adult women (EndoOnly; n = 352, Endo+IBS; n = 258), originally recruited via gyms, university sites and social media platforms, were identified from a longitudinal survey study exploring the physical and psychosocial impacts of pelvic pain. Health-related quality of life (HRQoL), psychological distress, pain, fatigue and menstrual symptoms data were collected at baseline, 12-months and 24-months using the World Health Organisation Quality of Life Assessment, Depression Anxiety and Stress Scale, pain severity numeric rating scale, Brief Pain Inventory, Pain Catastrophizing Scale (including rumination, magnification, and helplessness subscales), Fatigue Symptom Inventory and Menstrual Symptom Scale.

Results: Using linear mixed models, results indicated that individuals with Endo+IBS were more likely to experience lower HRQoL and higher functional pain disability, fatigue, and menstrual symptoms compared to individuals with EndoOnly over three years. Results showed significant linear declines in rumination, total pain catastrophising, pain severity and helplessness for both groups; however, the rate of change for the Endo+IBS group tended to diminish and change direction over time. Further, individuals with Endo+IBS were inclined to exhibit more complex change trajectories in psychological distress, magnification, and fatigue, with a trend towards worse outcomes overall.

Conclusion: Findings highlight the important implications of chronic disease co-morbidity and the need for interdisciplinary psychosocial healthcare, to help improve diagnosis, clinical management and health outcomes for individuals living with endometriosis and co-occurring IBS-type symptoms.