​March is here, and with it comes Endometriosis Awareness Month—a time to raise awareness and support for those affected!

What is endometriosis?

Endometriosis is a painful gynaecological condition where tissue similar to the lining of the uterus, grows outside the uterus (mainly on pelvic organs). The exact prevalence of endometriosis is unknown. This is partly due to the delays in diagnosis, which take an average of seven years. However, its global prevalence is estimated to affect 10% of women [1-3]. In other words, there are 190 million women worldwide who have to manage symptoms such as chronic and cyclic pain, risk of infertility and other comorbidities such as migraines, fibromyalgia and rheumatoid arthritis [2,3].

Symptomatic endometriosis often results in increased stress, fatigue, limited daily life activities, impaired work productivity, mental health disorders and disrupted sleep which in turn impacts the quality of life [4].

The connection between sleep, pain and mental health.

It is known that sleep and pain influence each other. Disrupted sleep increases pain sensitivity while pain itself can disrupt sleep [5-7]. Recent studies suggest that women with endometriosis are prone to disrupted sleep, sleep disorders and other psychological conditions such as anxiety and depression [8, 9]. Furthermore, mental health challenges are frequently observed in individuals with chronic pain, influencing and being influenced by both sleep and pain. Therefore, it's crucial to consider the entire context of sleep, pain and mental health in these women to fully comprehend the symptoms of endometriosis.

The associations between disrupted sleep, pain and other psychological comorbidities indicate that sleep can affect the ability to carry out daily functional activities in individuals with endometriosis[9].

However, current studies that examine this day-to-day impact of sleep and pain in women with endometriosis are currently lacking.

Understanding the impact of sleep and pain in women with endometriosis

Our study aims to contribute to the understanding of the relations between sleep and pain in woman with endometriosis. First, we want to understand the experienced symptoms of endometriosis by using a survey. Second, we want to dive deeper into the daily impact of sleep disruption and pain on other factors such as mood, stress and fatigue by using a symptom diary which has to be filled in twice a day (in the morning and in the evening). After completing the second study, the participants who filled in the diary for at least 80%, receive free psychoeducation about sleep, insomnia and pain from a clinical psychologist, licensed to provide cognitive behavioural therapy for insomnia (CBT-I). This session will be offered in a group setting and has the aim to provide information on sleep and pain and is also an opportunity for women to connect with peers.

Call to action:

We are starting patient recruitment soon!

If you know patients with endometriosis or if you would like to participate in this study, please contact zosia.goossens@vub.be for more information.

Zosia Goossens

2025Pain in Motion

References and further reading: http://www.sciencedirect.com/science/article/pii/S0049017214002765

1.Griffiths, M.J., et al., Endometriosis: recent advances that could accelerate diagnosis and improve care. Trends Mol Med, 2024. 30(9): p. 875-889.

2.Horne, A.W. and S.A. Missmer, Pathophysiology, diagnosis, and management of endometriosis. BMJ, 2022. 379: p. e070750.

3.Rahmioglu, N., et al., The genetic basis of endometriosis and comorbidity with other pain and inflammatory conditions. Nat Genet, 2023. 55(3): p. 423-436.

4.Sumbodo, C.D., et al., The relationship between sleep disturbances and endometriosis: A systematic review. European Journal of Obstetrics and Gynecology and Reproductive Biology, 2024. 293: p. 1-8.

5.Haack, M., et al., Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology, 2020. 45(1): p. 205-216.

6.Herrero Babiloni, A., et al., Sleep and pain: recent insights, mechanisms, and future directions in the investigation of this relationship. J Neural Transm (Vienna), 2020. 127(4): p. 647-660.

7.Koffel, E., et al., The bidirectional relationship between sleep complaints and pain: Analysis of data from a randomized trial. Health Psychol, 2016. 35(1): p. 41-9.

8.Zhang, Y., et al., Prevalence of sleep disturbances in endometriosis patients: a systematic review and meta-analysis. Front Psychiatry, 2024. 15: p. 1405320.

9.Arion, K., et al., A Quantitative Analysis of Sleep Quality in Women with Endometriosis. J Womens Health (Larchmt), 2020. 29(9): p. 1209-1215.