EFFECTS OF ENDOMETRIOSIS ON QUALITY OF LIFE (Benefit of combined hystero-laparoscopic surgery on quality of life and fertility performance in endometriosis)

Abstract

Background and Aims: The primary aim of my dissertation was to investigate the impact of endometriosis on quality of life and to highlight the positive outcomes of combined hystero-laparoscopic surgery on both quality of life and fertility in individuals affected by this condition. Endometriosis is a complex disorder characterized by severe symptoms, including debilitating pain, infertility, sexual dysfunction, and a significant decline in quality of life. The objectives of my research were multifaceted: (1) to enhance spontaneous pregnancy rates following surgical intervention for endometriosis and to evaluate the effectiveness of infertility treatments, including IVF; (2) to examine the correlation between the common locations of endometriosis and the associated levels of pain and distress; (3) to assess the impact of cesarean sections, abortions, and other gynecological procedures as potential late complications in the development of endometriosis; and (4) to advocate for comprehensive treatment strategies aimed at improving patients’ quality of life. Methods: Our findings were disseminated through four studies, comprised of three retrospective analyses and one prospective study. We engaged a participant group of 28 women with isthmocele-related symptoms, 533 women facing infertility associated with endometriosis, 777 women presenting with symptomatic endometriosis, and 87 women scheduled for laparoscopic surgery due to endometriosis. Participants completed self-administered questionnaires regarding their overall health perceptions and the distress caused by endometriosis. We developed a data collection framework, utilizing both hospital records and patient questionnaires. Follow-up assessments were conducted at 3, 6, 12, and beyond 24 months post-surgery. Results and Conclusions:The findings from our initial study deepened our understanding of the endoscopic surgical treatment for isthmocele and its relationship with endometriosis symptoms, particularly infertility. Our results indicated a significant association between a history of cesarean sections and an increased likelihood of developing endometriosis, validating our first hypothesis. Furthermore, we demonstrated that combined hysteroscopic and laparoscopic surgeries substantially improved fertility outcomes for endometriosis patients, reinforcing our second hypothesis. Additionally, our data indicated that combined hystero-laparoscopy considerably enhanced the quality of life for patients with endometriosis. The validated Endometriosis Health Profile-36 (EHP-36), along with the Visual Analog Scale (VAS) and the Numerical Rating Scale (NRS-11), were identified as effective tools for evaluating the quality of life among endometriosis patients, supporting our third hypothesis.