Beyond pain: employment status affects endometriosis-associated quality of life – a cross-sectional study

Introduction Endometriosis is a chronic condition that affects multiple aspects of women's lives, including physical health, emotional well-being, and socioeconomic stability. While pain is a well-recognized determinant of health-related quality of life (HR-QoL), the role of employment status on pain experience remains underexplored. Objective This study examines the association between employment status and HR-QoL, exploring its role as an independent variable beyond clinical symptoms and pain severity. Methods This cross-sectional study was conducted at the University Hospital of Geneva. Women with a confirmed diagnosis of endometriosis were included. Employment status was categorized as full-time employment (over 80%), part-time employment (80% or less), voluntary unemployment (not seeking employment), and involuntary unemployment (seeking employment). HR-QoL was measured using the Endometriosis Health Profile-30 (EHP-30), which includes components such as pain, control and powerlessness, emotional well-being, social support, and self-image. Statistical analyses included univariate and multivariable linear regression, adjusting for clinical, sociodemographic, and health-related variables. Results A total of 324 patients were included, with a mean age of 32 ± 7.2 years; 78.2% had deep infiltrating endometriosis. Prior surgery was reported in 34.5%. Regarding employment, 63.2% were employed (51.5% full-time, 11.7% part-time), while 36.7% were unemployed, including 26.2% by choice. Employment status was significantly associated with specific HR-QoL domains. Full-time and part-time employment were linked to lower EHP30 pain scores, with part-time employment showing a stronger association (B = -34.48, 95% CI: -58.00 to -10.88, p = 0.006) compared to full-time employment (B = -20.57, 95% CI: -40.70 to -0.43, p = 0.046). Conversely, unemployed women actively seeking work exhibited worse HR-QoL scores, particularly in social support (B = 34.95, 95% CI: 1.89 to 70.80, p = 0.048) and overall HR-QoL burden (B = 168.27, 95% CI: 30.60 to 205.91, p = 0.019). Self-image, control and powerlessness, and emotional well-being scores did not show statistically significant differences across employment groups (p > 0.05). Conclusion This study identifies employment status as an independent predictor of HR-QoL in women with endometriosis including pain and social support domain. Despite Switzerland’s comprehensive unemployment benefits, unemployed women still report poorer HR-QoL, underscoring the role of social integration, professional identity, and daily structure/routine as an independent variable for the evaluation of endometriosis burden. Future research should explore the impact of remote work, flexible employment arrangements, and workplace accommodations, which may improve workforce participation and well-being in women with endometriosis.