Impact of Endometriosis on Fatigue and Productivity Impairment in a Cross-Sectional Survey of Canadian Women

J Obstet Gynaecol Can. 2021 Jan;43(1):10-18. doi: 10.1016/j.jogc.2020.06.022. Epub 2020 Jul 18.


Objective: To evaluate fatigue burden and productivity impairments in Canadian women with a self-reported diagnosis of endometriosis (DxE).

Methods: From December 2018 to January 2019, Canadian women aged 18-49 years completed an online survey assessing fatigue via the Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form 6a questionnaire. Fatigue T-scores were compared between women with and without a DxE, by age and endometriosis symptom severity, using t tests. Women with a DxE completed the Work Productivity and Activity Impairment - Specific Health Problem (WPAI-SHP) questionnaire. The effects of age and hallmark endometriosis symptoms on productivity impairments were assessed via analysis of variance.

Results: Survey data included 2004 women with and 26 528 women without a DxE. Mean fatigue T-scores were 58.5 ± 10.1 in women with a DxE and 59.2 ± 10.1 in women with hallmark endometriosis symptoms (i.e., menstrual or non-menstrual pelvic pain/cramping, dyspareunia) versus 55.2 ± 9.4 in women without a DxE (both P < 0.001). Women with moderate or severe endometriosis symptoms had a mean T-score of 61.2 ± 9.4 versus 55.9 ± 10.1 for women with mild symptoms (P < 0.001). Women with moderate or severe hallmark endometriosis symptoms had mean T-scores of 59.6-62.9 versus 57.0-58.2 for women with mild or no symptoms (all comparisons P < 0.01). Women with a DxE reported 17.1% of work time missed, 41.8% impaired work ability, 46.5% overall work impairment, and 41.4% activity impairment per the WPAI-SHP. Women with a DxE aged 30-34 and 35-39 years consistently experienced the greatest effects of fatigue and productivity impairments.

Conclusions: Canadian women with a DxE experience a substantial fatigue burden and significant productivity impairments.

Keywords: absenteeism; endometriosis; fatigue; presenteeism.

MeSH terms

  • Absenteeism*
  • Adolescent
  • Adult
  • Canada / epidemiology
  • Cost of Illness
  • Cross-Sectional Studies
  • Efficiency*
  • Endometriosis / complications*
  • Endometriosis / epidemiology
  • Endometriosis / psychology
  • Fatigue / epidemiology
  • Fatigue / etiology*
  • Fatigue / psychology
  • Female
  • Humans
  • Middle Aged
  • Pelvic Pain / etiology
  • Pelvic Pain / psychology
  • Presenteeism*
  • Quality of Life / psychology*
  • Sickness Impact Profile
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology
  • Surveys and Questionnaires
  • Work
  • Young Adult