title: Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries.
abstract: OBJECTIVE
  To assess the impact of endometriosis on health-related quality of life (HRQoL) and work productivity.
  
  
  METHODS
  Multicenter cross-sectional study with prospective recruitment.
  
  
  METHODS
  Sixteen clinical centers in ten countries.
  
  
  METHODS
  A total of 1,418 premenopausal women, aged 18-45 years, without a previous surgical diagnosis of endometriosis, having laparoscopy to investigate symptoms or to be sterilized.
  
  
  METHODS
  None.
  
  
  METHODS
  Diagnostic delay, HRQoL, and work productivity.
  
  
  RESULTS
  There was a delay of 6.7 years, principally in primary care, between onset of symptoms and a surgical diagnosis of endometriosis, which was longer in centers where women received predominantly state-funded health care (8.3 vs. 5.5 years). Delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia, and heavy periods) and a higher body mass index. Physical HRQoL was significantly reduced in affected women compared with those with similar symptoms and no endometriosis. Each affected woman lost on average 10.8 hours (SD 12.2) of work weekly, mainly owing to reduced effectiveness while working. Loss of work productivity translated into significant costs per woman/week, from US$4 in Nigeria to US$456 in Italy.
  
  
  CONCLUSIONS
  Endometriosis impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity.
authors: Department of Public Health, University of Oxford, Oxford, UK. nnoaham.kelechi@berkshire.nhs.uk
authors: Kelechi E
authors: KE
authors: Nnoaham
authors: Lone
authors: L
authors: Hummelshoj
authors: Premila
authors: P
authors: Webster
authors: Thomas
authors: T
authors: d'Hooghe
authors: Fiorenzo
authors: F
authors: de Cicco Nardone
authors: Carlo
authors: C
authors: de Cicco Nardone
authors: Crispin
authors: C
authors: Jenkinson
authors: Stephen H
authors: SH
authors: Kennedy
authors: Krina T
authors: KT
authors: Zondervan
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002681:China; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D004526:Efficiency; D004651:Employment / Q000191:economics; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000523:psychology* / Q000628:therapy; D005060:Europe; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D009549:Nigeria; D011320:Primary Health Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D013020:South America; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D055815:Young Adult