Sleep disturbances, fatigue and psychological health in women with endometriosis: a matched pair case–control study

Published:August 20, 2021DOI:


      Research question

      What are the associations between endometriosis, pelvic pain symptoms, fatigue and sleep? Psychological health and quality of life in endometriosis patients with good versus bad quality of sleep were also examined.


      This matched pair case–control study included 123 consecutive endometriosis patients and 123 women without a history of endometriosis (matched to patients for age and body mass index). Endometriosis-related pelvic pain severity was rated on a 0–10 numerical rating scale. Fatigue was measured on a 1–5 Likert scale. Women also completed a set of self-report questionnaires for assessing sleep disturbances (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Insomnia Severity Index), psychological health (Hospital Anxiety and Depression Scale) and quality of life (Short Form-12).


      Painful endometriosis had an impact on fatigue (P = 0.006; η2p = 0.041) and sleep (P < 0.001; η2p = 0.051). Women with painful endometriosis reported significantly greater fatigue, poorer quality of sleep, higher daytime sleepiness and more severe insomnia than women without significant pain symptoms and controls. Poorer quality of sleep among endometriosis patients was associated with greater fatigue (P < 0.001; η2p = 0.130), poorer psychological health (P < 0.001; η2p = 0.135), and lower quality of life (P < 0.001; η2p = 0.240).


      Pelvic pain (rather than endometriosis in itself) is associated with fatigue and sleep disturbances, with poor sleep having a detrimental impact on women's psychological health and quality of life.


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      Federica Facchin, PhD, is currently an Assistant Professor in the Department of Psychology at the Catholic University of the Sacred Heart (Milan, Italy). Her primary research interests are focused on the psychological impact of benign gynaecological conditions (especially endometriosis). She is a junior ambassador of the World Endometriosis Society.
      Key message
      In women with endometriosis, the presence of moderate to severe pelvic pain is associated with fatigue and sleep disturbances, which may lead to impaired psychological health and quality of life. Sleep quality should be routinely assessed in this population; medical and psychological treatment may decrease pain, and thus improve sleep and quality of life.