Endometriosis is a chronic, inflammatory, estrogen-dependent disease. Its hallmarks are the presence of active epithelium and/or endometrium-like lining outside the uterine cavity [1, 2]. The severity and clinical presentation of endometriosis vary widely. The most common foci are in the ovaries, fallopian tubes, rectouterine pouch (pouch of Douglas), and abdominal peritoneum. In cases of deeply infiltrating endometriosis, lesions may also develop in the bladder, intestines, and subperitoneum. Less commonly, they occur in locations such as the diaphragm and lungs [3, 4].

Endometriosis is estimated to affect 10–15% of women of reproductive age and 2–5% of postmenopausal women, representing approximately 176 million women worldwide [5, 6, 7, 8, 9]. It is detected in up to 50% of women undergoing infertility treatment [5]. The symptoms of endometriosis are varied and non-specific; hence, they are often mistaken with symptoms of other conditions. The most commonly reported symptoms include painful menstruation, heavy or irregular menstrual bleeding, and pelvic pain [1]. The condition may also be accompanied by pain during intercourse, pain or bleeding during urination and defecation, painful rectal bleeding, infertility, cyclic chest pain, coughing, or hemoptysis [2, 4]. However, endometriotic lesions do not always produce clinical symptoms [5]. One of the challenges in diagnosing endometriosis is its undetermined etiopathology [10, 11, 12, 13]. Due to the complex nature of its symptoms and the lack of specific biomarkers, the average time to diagnosis is 9.6 years [14], significantly impacting the quality of life of affected women [11, 12, 13, 15].

Chronic pain, discomfort, and other symptoms significantly limit patients’ daily functioning, affecting their professional activities, social and family relationships, and emotional well-being [11, 12, 13]. Several validated tools are available to assess the quality of life of women with endometriosis across various domains: Short Form 36 (SF-36), Short Form 12 (SF-12), Nottingham Health Profile (NHP), World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF), and Endometriosis Health Profile-30 (EHP-30) [16, 17, 18, 19, 20]. Therefore, this study aimed to assess the impact of endometriosis on the quality of life of Polish women, based on determinants identified through a comprehensive literature review: age, education, place of residence, parenthood, current disease stage, and disease duration. Considering the high variability and severity of endometriosis symptoms across different populations, the use of a newly developed questionnaire may enable the identification of previously unrecognized factors that influence the quality of life of women with endometriosis in Poland.

This study was conducted in a cohort of 100 Polish women with endometriosis. Participants voluntarily completed the questionnaire after being informed that their responses would remain anonymous and used exclusively for scientific purposes. The study was conducted between April and October 2023. The inclusion criteria included female sex and a confirmed diagnosis of endometriosis.

The research tool used to assess the impact of endometriosis on women’s quality of life was a newly developed, unvalidated questionnaire. The questionnaire was written in colloquial language understandable to all patients and was administered electronically via Google Forms (https://forms.gle/QgygjJjU4x5wAvB37). It was distributed through social networks and support groups for women with endometriosis. Participation was voluntary, anonymous, and conducted entirely online. The use of an unvalidated instrument may limit the generalizability and comparability of the findings with those of studies that use standardized Quality of Life (QoL) measures. This limitation is acknowledged in the Discussion section and should be considered when interpreting the results.

Respondents answered closed-ended questions, including single-choice and multiple-choice items, including one question that allowed a typed response for age. The first section of the questionnaire collected basic demographic information, including age, marital status, place of residence, education level, and type of work performed. The subsequent section gathered information on disease stage (stage I, II, III, or IV; this was not subject to secondary verification), disease duration (1–5 years, 6–10 years, or $>$10 years) and any accompanying pain symptoms.

The final section of the survey included specific questions designed to assess quality of life. The study examined various aspects of daily life, including concomitant symptoms and complaints, treatment methods and their effectiveness, fertility and pregnancy complications, daily activities, physical activity, professional work, financial difficulties, sexual life, sleep, relationships with loved ones, fulfillment of plans/dreams/goals, fatigue, as well as positive and negative emotions. A comparative analysis of the respondents was conducted based on age, education, place of residence, parenthood status, disease severity classification, and disease duration. Correlations between variables were tested using the Chi-square ($\chi$²) test. This test compares the observed frequencies with the frequencies expected under the assumption of independence, helping to test whether the two variables are associated. Data analysis was performed using Statistica (Cloud Software Group, Inc., 2023; Fort Lauderdale, FL, USA, version 14), and Microsoft Excel (Microsoft Office 2019; Redmond, WA, USA, version 2025). A p 0.05 was considered statistically significant.

The study group consisted of women with endometriosis aged 18 to 55 years.

Chronic pain (with typical cyclicity and severity) and infertility resulting from endometriosis, alone or in combination, can significantly reduce the quality of life of affected women due to significant social and psychological impacts on daily activities, intimate relationships, family planning, education, work, mental health, and emotional well-being [12, 13, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25]. Sexual functioning is a critical aspect of overall functioning, closely linked to other domains and affected by disease symptoms [26]. Dyspareunia occurs four times more frequently in women with endometriosis and five times more frequently in those with peritoneal endometriosis than in controls [27]. Previous studies have reported decreased satisfaction with sexual life and its negative impact on relationships with partners [21, 26, 28]. Baczek et al. [29] observed that women with a history of endometriosis lasting more than 3 years reported dyspareunia, bladder pain, and lower back pain significantly more often. In addition, the severity of dysmenorrhea seems to be associated with a lower quality of life. However, chronic pelvic pain and dyspareunia in endometriosis may not negatively impact the quality of life of fertile Turkish women, even in the most advanced stages of the disease [30]. Worse sexual quality of life in women with endometriosis was significantly and independently associated with the presence of dyspareunia, more severe dysmenorrhea, and unemployment [31]. In the current study, no correlations were found between the quality of sexual life and the severity or duration of the disease. According to Łuczak-Wawrzyniak et al. [32], endometriosis does not necessarily lead to a deterioration of quality of life, as it may result in the redistribution of personal resources that help patients achieve goals and fulfill important life needs. Women adapt to the course of the disease, enabling them to maintain good relationships, plans for the future, and experience life satisfaction [32].

Wilk [33] suggests that prolonged pain can negatively affect the psychological well-being. According to Wilk [33], there is a strong association between patients’ pain complaints and the onset of depressive or anxiety disorders. In the present study, more than 90% of the respondents reported using painkillers. Regarding emotions, most respondents reported experiencing sadness and depression more frequently than joy and happiness. Women without children were significantly more likely to report heightened feelings of societal rejection. Matasariu et al. [34] also showed a significant presence of high infertility-related stress across all age groups, contributing to depression and social anxiety.

Ruszała et al. [35] noted that fatigue becomes increasingly prevalent in women’s daily lives as the disease progresses. Patients with endometriosis also exhibit poor sleep quality [36], which is associated with dysmenorrhea, dyspareunia, pelvic pain, low levels of physical activity, and reduced intake of dairy products, fruits, and nuts [37]. The current study found that nearly half of the participants were dissatisfied with their sleep quality. However, women who had suffered from endometriosis for more than 5 years reported significantly higher sleep satisfaction scores. According to Łuczak-Wawrzyniak et al. [32], this can be attributed to adapting to and accepting the disease.

For most individuals, having children is highly important; thus, infertility represents a major life challenge [38]. A significant concern for female patients with endometriosis is the inability to conceive or carry a pregnancy, preventing them from fulfilling their desire to have children. Previous studies have demonstrated that endometriosis-related infertility adversely impacts quality of life and exacerbates anxiety and depression [39, 40, 41, 42, 43].

Bień et al. [43] observed that the main clinical factors influencing the quality of life in women with endometriosis are difficulties conceiving and sexual problems. This study demonstrated that women without children reported significantly stronger feelings of societal lack of acceptance due to infertility (p = 0.03) and were significantly more likely to report a higher impact of endometriosis on preventing the realization of life goals (p = 0.03). Moreover, they were significantly more likely to rate their quality of life as “neither good nor bad” (p = 0.049). All the participants in this study were more likely to feel sad and depressed than happy, and nearly half were dissatisfied with their sleep quality. However, it appears that a lack of children may have a significant impact on the quality of life of women with endometriosis. This suggests the need for care and emotional support in infertility management, especially when associated with endometriosis [44]. In this study, we used a newly developed questionnaire written in clear, colloquial language accessible to all patients. It was administered electronically and distributed through social networks and support groups for women with endometriosis, which may have introduced selection bias. The population may overrepresent patients who are more symptomatic or actively engaged. Validated tools are commonly used in research to assess quality of life [16, 17, 18, 19, 20]. However, Dowrick et al. [45] have shown that the context and characteristics of the studied population may influence the measurements obtained using validated questionaries. In particular, when the tools have not been validated in the population of interest, it may lead to measurement errors and uncertain conclusions. Becker et al. [2] noted the heterogeneity of endometriosis symptoms between populations from six different European countries. Poland had the highest proportion of women experiencing at least one of the three typical symptoms of endometriosis (pelvic pain, pain during or after intercourse, or dysmenorrhea [91%]), while Hungary had the lowest percentage (68.8%). In addition, Polish patients reported severe pain more frequently. Alternatively, global assessment measures based on direct self-reporting [46, 47] or online surveys [48] can be used. While validated instruments offer greater objectivity, they are often time-consuming. Non-validated instruments such as global assessments are easier to administer but may be more subjective [49].

To date, studies examining the impact of endometriosis on quality of life have focused on different aspects of patient well-being. In Polish populations, the findings are sometimes contradictory. For example, Łuczak-Wawrzyniak et al. [32] concluded that endometriosis does not necessarily lead to a deterioration in women’s quality of life, whereas Bień et al. [43] showed that difficulties conceiving and sexual problems adversely affect the quality of life of affected women. Surgical treatment plays an important role in managing endometriosis, particularly in severe or treatment-resistant cases. While laparoscopic excision can relieve pain and improve fertility, it may also lead to complications [50, 51, 52]. Sexual health in women with endometriosis is multifactorial, influenced not only by the disease itself but also by coexisting conditions such as pelvic floor hypertonicity and chronic pelvic pain [53, 54]. These overlapping factors contribute to dyspareunia and broader sexual dysfunction, underscoring the need for a multidisciplinary, biopsychosocial approach to management.

Therefore, the aim of this study was to assess the impact of endometriosis on the quality of life of Polish women based on determinants extracted from a comprehensive literature search: age, education levels, place of residence, parenthood, current disease stage, and duration of disease. Considering the high variability and severity of endometriosis symptoms across different populations, the use of a newly created questionnaire could uncover previously hidden factors influencing the quality of life of women with endometriosis in Poland.

Endometriosis is a condition that affects multiple aspects of a woman’s life. Our findings indicate that its negative impacts are complex and multidimensional, with most participants reporting sadness and depression rather than happiness, and nearly half expressing dissatisfaction with their sleep quality. While validated instruments offer greater objectivity, they are often time-consuming. Non-validated instruments, such as global assessments, are easier to administer but may be more subjective.

The data presented in this study are available upon request from the corresponding author.

EM study conception, data collection and analysis, drafting of the manuscript; KC-W drafting of the manuscript; study conception, design and supervision; KW study conception, design and supervision; MWierz and MW analysis and interpretation of data, revision of the manuscript for important intellectual content. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work

The study participants were informed that participation in the study was anonymous and voluntary, and that the results obtained would only be used for scientific purposes. The ethical review and approval were waived for this study by the Bioethics Committee of Poznan University of Medical Sciences, due to the fact that it was not a medical experiment and did not involve patients, and as such, approval was not necessary according to Polish law (KB-282/25, date 23.04.2025). The study was carried out in accordance with the guidelines of the Declaration of Helsinki.

Not applicable.

This research received no external funding.

The authors declare no conflict of interest. Katarzyna Wszołek and Karolina Chmaj-Wierzchowska are serving as the Guest editors of this journal. We declare that Katarzyna Wszołek and Karolina Chmaj-Wierzchowska had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Michael H. Dahan.