Silent Battles: The Impact of War on the Mental and Physical Health of Endometriosis Patients

Background

Endometriosis is a chronic, inflammatory disease affecting 1 in 10 women of reproductive age worldwide. It is characterized by a range of debilitating symptoms which collectively impair patients’ quality of life. While stress is a well-documented factor known to exacerbate endometriosis symptoms, the impact of extreme and prolonged external stressors, such as ongoing war, on disease progression and patient well-being hasn’t been thoroughly studied.

On October 7, 2023, Israel faced a severe terror attack impacting Jewish and non-Jewish victims alike. Since then, Israel has been involved in an on-going conflict on multiple fronts. This study explores the compounded effects of ongoing war on women with endometriosis, focusing on symptom severity, physical and mental health, and illness perception.

Materials & Methods

A cross-sectional survey study was conducted in Israel in August 2024, recruiting 841 women with confirmed diagnosis of endometriosis and/or adenomyosis through social media platforms and endometriosis clinics. The survey assessed the impact of the war on participants’ lives, physical, and mental health. It consisted of several validated measures as well as sociodemographic and clinical questions. Statistical analyses included descriptive statistics, univariate statistics for assessing temporal changes in symptoms severity and perceptions across three timepoints (pre-war, 2 months post-war, ∼1 year post-war), and correlation between war-related stressors, mental status, and health outcomes. Univariate and multivariable logistic regression models were employed to identify factors associated with symptom worsening, adjusting for sociodemographic characteristics, medical conditions, and war-related factors.

Results

82.8% of participants were directly affected by war-related stressors. Mental health deteriorated substantially, with anxiety rates increasing from 34.7% to 94.1% and depression from 39.6% to 89.3% (p<0.001). Physical health was also affected, with 77.4% reporting worsening endometriosis symptoms and 62.5% indicating overall medical decline. All specific symptoms, including pelvic pain, digestive and urinary symptoms, dyspareunia, fatigue and more, showed significant deterioration (p<0.001). Additionally, 38.9% and 14.4% of participants reported increased usage of pain and hormonal medications, respectively, indicating higher symptom-management needs. Multivariable analysis revealed significant associations between worsening in symptom severity to war-related stressors (aOR=1.24, 95%CI=1.07-1.45), war-related stress levels (aOR=1.83, 95%CI=1.50-2.22), depression and anxiety levels (aOR=2.00, 95%CI=1.52-2.63), and impaired healthcare accessibility (aOR=1.64, 95%CI=1.04-2.57). Negative illness personification was associated with worse outcomes (aOR=1.37, 95%CI=1.12-1.67), while positive illness personification showed protective effects (aOR=0.77, 95%CI=0.59-0.99).

Conclusions

This study demonstrates the profound impact of war and war-related stress on both the physical and mental health of endometriosis patients, highlighting the critical need for targeted healthcare interventions and psychological support during times of conflict.