Associations of health and lifestyle factors with multidimensional quality of life among women with endometriosis: a cross-sectional study

Abstract

Introduction Endometriosis is a chronic disease associated with pain, fertility difficulties, and reduced quality of life (QoL). Beyond clinical symptoms, health-related and lifestyle behaviors may influence the long-term impact of the disease. This study aimed to assess multiple QoL dimensions in women with endometriosis and examine their associations with disease-related symptoms, body mass index (BMI), and lifestyle characteristics. Methods A cross-sectional online survey was completed by 153 women aged ≥ 18 years with self-reported endometriosis. Data included sociodemographic characteristics, body weight, physical activity, diet, smoking, and digestive symptoms, including painful defecation. The Endometriosis Impact Questionnaire evaluated physical, psychological, social, sexual and intimate, fertility, educational, employment and financial, and lifestyle QoL across three recall periods. Non-parametric tests and multivariate linear regression models assessed group differences and factors associated with QoL dimensions and overall impact. Results The greatest burden was observed in fertility, physical, and psychological dimensions, particularly during the previous 12 months. Body-weight change since symptom onset was associated with poorer outcomes across all QoL domains. BMI showed coding-dependent associations: continuous BMI predicted greater physical and psychological impact, whereas BMI ≥ 25.0 kg/m2 was linked to lower impact in physical (β=−0.42; p = 0.005), sexual and intimate (β=−0.31; p = 0.044), and employment and financial QoL (β=−0.31; p = 0.049). Painful defecation was associated with greater psychological and sexual and intimate impact and higher overall impact. Smoking was associated with greater lifestyle impact (β=0.38; p < 0.001) and higher overall impact (β=0.17; p = 0.042). Dietary supplement use was associated with lower fertility impact (β=−0.18; p = 0.049), whereas following a dietary regimen was associated with higher fertility impact (β=0.22; p = 0.014). Conclusion Endometriosis substantially affects multiple life domains, particularly fertility and physical and psychological well-being. Weight change, painful defecation, and smoking were linked to poorer QoL, while BMI demonstrated complex domain-specific associations. Integrated medical and lifestyle approaches may improve long-term disease impact.