369 A systematic review to identify and assess the mental health sequalae amongst women with endometriosis with or without chronic pelvic pain (THE ELEMI PROJECT)

Abstract

Introduction/Background: Endometriosis is a complex, chronic gynaecological condition impacting approximately 176 million women globally. It is associated with symptoms such as chronic pelvic pain (CPP), dysmenorrhoea, menorrhagia, sexual dysfunction and infertility. During several points in the lifecycle of this chronic disease, women bear the consequent burden of mental health (MH) difficulties, due to the complex symptomatology and comorbidities of endometriosis. For example, delayed diagnosis (the average time to diagnose being 7–8 years), undergoing often repeated excision surgeries, and difficulties with subfertility and sexual activities, and suffering with long-term CPP and analgesic use, can all negatively influence MH and can have significant impact on the psychological, sexual, relationship and social functioning of affected women. Therefore, a systematic review was conducted as part of the evidence synthesis phase of the ELEMI project to identify and assess this complex relationship with a view to report on any knowledge and clinical practice gaps. Methodology:L The systematic protocol was published in PROSPERO (CRD42020181495). MeSH terms developed include Endometriosis, Depression, Anxiety, Low mood, Psychiatry comorbidity, Women’s health and CPP. All studies and material published between January 1980 to June 2020 in English and participants were included. Results Out of 28 studies included in the systematic review, 17 were included in the meta-analysis (anxiety: 6, chronic pelvic pain: 3, depression: 11, and dyspareunia: 3) which described the prevalence and extent of MH symptoms in endometriosis and/or CPP. The pooled prevalence for anxiety was found to be 31.8% (95% CI: 26.5% - 37.1%), whilst for depression 28.9% (95%CI: 8.6%-49.2%). Pooled prevalence for CPP was high at 57.2% (95%CI: 7.0%, 107.4%) and pooled estimate of mean SF-MPQ for chronic pain to be 13.09 (95%CI: 7.13, 19.05). Computed prevalence for dyspareunia was also identified to be high (prevalence: 54.9%, 95%CI: 43.9%, 65.9%). The narrative analysis showed depression and anxiety to be the most commonly reported MH symptoms. None of the papers indicated if these had received a clinical diagnosis or were being treated. Generic MH assessments were used in all samples. Thus, whilst it is vital to identify the reporting of these symptoms, their clinical significance is yet to be comprehensively ascertained, and further exploratory evidence is required (figure 1). Conclusion Limited research is currently available to evaluate the MH sequalae of endometriosis. Further comprehensive research is required to fully assess and treat the MH associated endometriosis patient reported outcomes.