It is "pain" that causes sleep disturbances and fatigue in endometriosis patients

It is

The severity of the pain is related to the worsening ratio of sleep and daily life quality.

Key Points


  • The pain is the reason for fatigue and sleep disturbances, due to poor life quality and psychological problems in endometriosis patients.


  • It has previously been analyzed that endometriosis is related to sleep disturbances.
  • The present study revealed that it is the pain that causes negative effects in patients with endometriosis.

What's done here:

  • A matched pair case–control study evaluated 123 women with, and 123 women without endometriosis.
  • Endometriosis-related pelvic pain severity was assessed by the surveys [Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and QoL (Short Form-12), and fatigue was scaled based on its severity.
  • Groups were statistically compared. 

 Key Results:

  • Suffering from fatigue and sleep disturbance were significantly higher in patients with both endometriosis and pain, compared to the control group.
  • Painful endometriosis causes fatigue and sleep problems including poor sleep quality, day time sleepiness, and insomnia, compared to controls and endometriosis patients without pain.
  • Endometriosis patients with poorer quality of sleep had more fatigue, poorer psychological health, and lower quality of life.


  • Pelvic pain patients without endometriosis should be included in a separate group for comparison.
  • The control group may contain undiagnosed asymptomatic endometriosis patients.
  • The effect of hormonal treatment was not evaluated.

Lay Summary

Endometriosis has been studied previously about its effects on quality of life and the possible effects on sleeping periods.

The study conducted by Federica Facchin et al. questioned the reason for endometriosis to cause sleep disturbance. The authors have divided the group of patients with endometriosis into those having pain or not. The third group of patients without endometriosis diagnosis were selected as the control group.

Endometriosis-related pelvic pain severity was evaluated by several surveys including Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and QoL (Short Form-12). The fatigue was scaled up from 1 to 5 according to its severity.

It appeared that the patients with both endometriosis and pain were suffering from fatigue significantly more, compared to the control group. Sleep disturbance was also higher in the painful endometriosis group. Once the pain is present, the life quality related to sleep disturbance was more significant. However, insomnia was not a significant problem in patients with endometriosis without pain.

Not to include a pelvic pain group of patients without endometriosis, and not questioning the effects of infertility or hormone or medications on the sleep quality are the main limintations of the study, authors mentioned.

This interesting study highlights the importance of questioning the symptomatology of endometriosis on life quality alterations. "Pelvic pain, rather than endometriosis in itself, is associated with fatigue and sleep disturbances, with poor sleep having a detrimental impact on women's psychological health and quality of life" the authors concluded.

Research Source:

sleep disturbance fatigue endometriosis insomnia hormones infertility


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