الفهرس 
Reproductive HealthOnly 14 pages are availabe for public view
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Abstract
Endometriosis is a puzzling disease with little known about its true prevalence, its distribution in the population, or its risk factors. It is thought to be a relatively common disease, however, with an estimated prevalence among women of reproductive age as high as 10%. Given this relatively high prevalence and that women with the disease may have severe pelvic pain and infertility, endometriosis poses a significant public health problem.
Unfortunately, data on the impact of endometriosis on health status, and quality of life among women in developing countries are scant. Furthermore, the basic epidemiology of endometriosis among Egyptian women did not warrant the attention of the researchers. Only one study addressed the risk factors for women with endometriosis among Egyptian women could be traced. Moreover, the impact of this chronic disease on women’s QoL and the health seeking behaviour of those women have not been previously studied.
The aim of the present work was to study risk factors and QOL among women with endometriosis in Alexandria. Moreover, it also aimed to identify different health care seeking behaviours among patients with endometriosis.
In order to accomplish the aims, two approaches were used in the present study; a case-control approach and a follow up approach.
The study was carried out in El-Shatby University Maternity Hospital affiliated to Alexandria University, Gamal Abd El-naser and Abu Kir hospitals affiliated to the Health Insurance Organization and some other private hospitals in Alexandria.
- Women who were diagnosed by operative laparoscopy as having endometriosis attending the previously mentioned hospitals constituted the cases for this study. Those who could be followed up for 3 months after the operative laparoscopy constituted the study population for the follow up study.
- Women with unrelated minor conditions attending the previously mentioned hospitals for different reasons constituted the hospital-based controls.
For conduction of the study, the following tools and techniques were used:
A- Structured interview using a set of pre-designed questionnaires was administered to the sampled women to collect data related to; the case-control study, measuring patients’ quality of life, endometriosis-related symptoms, patients’ health seeking behavior, and follow up study. (Appendices I- IV).
B- Anthropometric measurement for the participants of the case-control study.
The study revealed the following results:
• Factors associated with endometriosis.
- Following the use of the significant variables detected from the univariate analysis, the logistic regression model for women with endometriosis uncovered that negative history of gravidity was associated with about 4 times increase in risk of developing endometriosis. Women with short cycles (≤ 27 days), and those with irregular cycles were 6 and 3 times more likely to develop endometriosis, respectively. Moreover, nearly 2-fold increase in the risk of developing endometriosis was observed among women with positive history of IBS (AOR=1.96, CI [1.03-3.8]). Being overweight (BMI of 25-29) was associated with a 50% decrease in risk of endometriosis (AOR=0.48, CI [0.26-0.85]). Finally, women who had one or more relatives with endometriosis were 1.2 times more likely to have endometriosis [(AOR=1.21, CI (0.19-0.43)].
- Among parous women, the variables which proved to be significantly associated with endometriosis by the univariate analysis were entered into a logistic regression model. The model identified that late age at first pregnancy, negative history of breast feeding, and history of concurrent infertility were the factors associated with endometriosis among parous women (AOR= 9.2,7.3,37.1, respectively).
• Frequency of endometriosis-related symptoms by Endometriosis-Symptoms Checklist
- Overall, menstrual cramping, fatigue or weariness, and lower back pain were the most frequent 3 symptoms reported by the patients as happening most of the time during the last 12 months (65.5%, 42.7%, and 25.5%, respectively).
- Regarding the women’s reports of total symptom distress from individual symptoms, menstrual cramping, fatigue or weariness, and non-period pelvic pain gained the highest TSD among all endometriosis reported symptoms.
• Description of the endometriosis-related pain
- The results revealed that, the percentage of women who reported experiencing pain allover the month was surprisingly high, accounting for one third of them (34.5%), while nearly half of the patients (52%) reported increase in their pain symptoms before and during menstruation. Lower back pain and mid-pelvic pain were the most reported pain sites (92.1% & 83.3%). Pain was reported to be the women’s main complaint in about half of the patients.
• Health seeking behaviour among women with endometriosis
- All the sampled women preferred to go to private clinics when they experiencing any health problem, and all of them visited a gynecologist during the last 3 months because of complaints related to endometriosis. Furthermore, the majority of the patients (60.9%) reported having to visit the doctor from 3 to 5 times during the last 3 months, with mean number of visits of 3.39 + 1.52 SD.
- Only thirty patients (27.3%) mentioned that their treating physicians prescribed drugs for treating endometriosis-related symptoms during the last 3 months. More than half of the patients (59.1%) did not know if endometriosis is curable or not. Among the twenty women (18.2%) who thought endometriosis could be cured, 55% thought that both surgical treatments and drugs were available methods for treating endometriosis.
• Diagnostic Delays (DD) of women with endometriosis
- Overall, nearly one fourth of cases (23.6%) experienced symptoms for nearly 10 years, while 40% of the women reported having 3 to 6 years DD of endometriosis. Fortunately, 70% of the women reported less than 2 years of delay between first seeking medical care and diagnosis. Therefore, the TTD of the patients was about 6 years (5.97 years + 4.02 SD).
- Regarding the women’s reported causes of DD, the highest percentage of women (40.9%) reported that their physicians used to normalize their symptoms or say ”these are just normal period pains”. While, 36.1% of the women themselves thought that they were just unlucky to have these painful periods.
• Reliability and validity of the Arabic Version EHP-30
- The internal consistency of the scales of Arabic Version of the EHP-30 as measured by Cronbach’s α was 0.89 for the 27- items core questionnaire, and 0.58 for the 23-items modular questionnaire.
- Concerning the validity of the Arabic Version of the EHP-30, the results of the principal component factor analysis with Varimax Rotation of the Core questionnaire revealed that, four factors were extracted with Eigen values above 1.00 (8.38, 4.57, 2.11, and 1.90, respectively). They explained 60.93% of the total variance. Factor one explained 31.03% of the total variance, while factor 4 explained only 7.05% of the total variance. Moreover, the factor loadings of items and sum of factor items of the Core Questionnaire of the Arabic Version of the EHP-30 were revealed. Overall, factor 1 included 10 items, factor 2 was loaded by 6 items, factor 3 containing 6 items, and finally factor 4 loaded by 5 items.