Chronic fatigue an under-recognised symptom of debilitating endometriosis, study finds

Treating symptoms alongside disease could improve quality of life for millions of women

Fatigue is an under recognised symptom of endometriosis which could help identify the condition and improve the quality of life for millions of women, a study has said.

Women diagnosed with endometriosis were twice as likely to also have chronic fatigue, researchers found, even when tiredness caused by other symptoms like pain or depression was accounted for.

“These findings suggest that endometriosis has an effect on fatigue that is independent of other factors and that cannot be attributed to symptoms of the disease,” said Professor Brigitte Leeners, of University Hospital Zurich, who led the research.

It also means treating fatigue in medical care for the disease could significantly improve the wellbeing of women with the condition and should be a routine part of their medical care.

Endometriosis is a gynaecological disease which affects between 6 and 10 per cent of women and means cells which usually grow inside the womb develop elsewhere in the pelvic region.

It can cause agonising pain and infertility if these cells, which build up and break down in line with hormones released throughout the menstrual cycle, develop in structures like the fallopian tubes.

However, because of the wide variety of symptoms and the various places cells can develop it can be difficult to diagnose. In some cases it requires keyhole surgery to remove the endometrial cells.

For the research published in the journal Human Reproduction Professor Leeners’ team recruited 1,120 women, including 560 diagnosed with endometriosis, from hospitals in Switzerland, Germany and Austria.

It found 50.7 per cent of women with endometriosis suffered with chronic fatigue, compared to 22.4 per cent of those without.

Fatigue also made a host of other conditions more likely, including a seven-fold increase in chances of insomnia and a four-fold increase in depression.

However, fatigue was common even without these symptoms and Professor Leeners said this is likely to be down to the repeated inflammation caused by endometrial lesions activating the immune system.

Chronic fatigue, sometimes referred to as myalgic encephalomyelitis, was long thought to be a mental health condition but recent studies have linked it to cell signalling molecules called cytokines which are part of this immune response.

“We believe that in order to improve the quality of life for women with this condition, investigating and addressing fatigue should become a routine part of medical care,” Professor Leeners added.

“Doctors should investigate and address this problem when they are discussing with their patients the best ways to manage and treat the disease.”