Endometriosis, chronic pain, anxiety, and depression: A retrospective study among 12 million women

Background: There is a lack of information regarding the impact of the physical symptoms associated with endometriosis and chronic pain on the mental health and well-being of affected women. Thus, our study aimed to evaluate the relationship between endometriosis, chronic pain, anxiety, and depression.Objective: Our study aimed to evaluate the relationship between endometriosis, chronic pain, and mental health disorders among women registered in a large database until 2014. Study design: This was a retrospective population-based study involving 12,904,324 hospitalized women from the Healthcare Cost and Utilization Project (HCUP) database between 2007 and 2014. We calculated the prevalence of chronic pain, endometriosis, anxiety, and depression during the study period. We used multivariate logistic regression to examine the relationship between these variables.Results: An upward pattern was noted in the prevalence of chronic pain, while an opposite trend was seen for endometriosis during the study period. After adjusting for sociodemographic characteristics and comorbidities, including depression, the highest odds ratio of experiencing anxiety appeared in the group with both chronic pain and endometriosis (OR = 2.719, 95 % CI 2.481-2.979). Limitations: HCUP is a cross-sectional administrative database that does not link patients' records over the years. Thus, we could not establish any temporal association between endometriosis, chronic pain, anxiety, and depression.Conclusion: Potential associations were identified between endometriosis, with and without chronic pain, anxi-ety, and depression. We recommended that clinicians provide proper medical management of endometriosis-related pain through symptom management and adequate counseling for those suffering from anxiety and depression.