title: Anxiety, coping skills and hypothalamus-pituitary-adrenal (HPA) axis in patients with endometriosis.
abstract: BACKGROUND
  Endometriosis is an inflammatory disease that is defined by growth of endometrial tissue outside the uterus, resulting in pain, infertility, and emotional distress. Previous studies have shown that the HPA axis is compromised in patients with chronic, painful diseases, including endometriosis. However, the underlying mechanisms and the physiological and emotional consequences of dysfunctions in the HPA axis in these patients are largely unknown. We aimed to understand whether diurnal circulating cortisol levels in women with endometriosis are affected and how this impacts their emotional and behavioral responses.
  
  
  METHODS
  Thirty-two patients with endometriosis and 36 healthy control women provided saliva samples and completed a series of psychological questionnaires. Salivary cortisol levels were measured in duplicate using a colorimetric immunoassay.
  
  
  RESULTS
  There were significant differences in average cortisol levels between endometriosis patients and controls. A negative correlation was found between cortisol levels and infertility and dyspareunia. Furthermore, incapacitating pain was found to be a strong predictor of hypocortisolism. Women with endometriosis reported higher levels of trait anxiety, but showed no differences in perceived stress or in coping styles compared to the control group.
  
  
  CONCLUSIONS
  This study supports previous reports of hypocortisolism as a biomarker of aberrant HPA responses in women with endometriosis. Moreover, it provides further insight into the link between HPA axis dysregulation, emotional responses, and the high comorbidity between endometriosis and other inflammatory conditions.
authors.affiliation: Department of Psychology, Ponce Health Sciences University, Ponce Research Institute, Puerto Rico, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Quiñones
authors.affiliation: Department of Biology, Nova Southeastern University, Fort Lauderdale, Florida, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Urrutia
authors.affiliation: Department of Psychology, Ponce Health Sciences University, Ponce Research Institute, Puerto Rico, USA.; Department of Physiology, Ponce Health Sciences University, Ponce Research Institute, Puerto Rico, USA.
authors.forename: Annelyn
authors.initials: A
authors.lastname: Torres-Reverón
authors.affiliation: Nuffield Department of Obstetrics and Gynecology, University of Oxford, John Radcliffe Hospital, Oxford, UK.
authors.forename: Katy
authors.initials: K
authors.lastname: Vincent
authors.affiliation: Department of Microbiology, Ponce Health Sciences University, Ponce Research Institute, Puerto Rico, USA.
authors.forename: Idhaliz
authors.initials: I
authors.lastname: Flores
keywords: Endometriosis; HPA axis; anxiety; cortisol; infertility; pain