Differences in the Time Course of Disease Progression, Quality of Life and Health Service Utilization in Women with Endometriosis

Abstract

Introduction This study aimed to identify different subgroups (clusters) of patients (n = 182) based on the previously defined variables “age” and “diagnostic delay” in order to identify varying needs of (socio-)medical care. Methods Five clusters were identified by two-step cluster analysis (SPSS 23.0). The mean values for parameters of quality of life, time course of disease progression and health service utilization were compared by chi-square and Kruskal-Wallis H test, and tested for correlations using Spearman's correlation coefficient. Results Clusters I and II patients recognized their endometriosis symptoms at a relatively late age. The results showed a short diagnostic delay and a low subjective disease burden, although cluster I was characterized by a high level of fatigue. Cluster III results indicated that a lack of social support and comparatively long diagnostic delay were major problems in this group. The women in cluster IV had the worst quality-of-life scores and a below-average utilization of services. Statistical analysis showed a significant association between an early age of onset of endometriosis symptoms and a very long delay in diagnosis. These women perceived their menstrual symptoms as “normal” or as “hypochondria”. Cluster V patients were mainly concerned about maintaining their work ability and employment. Conclusions In gynecological practice, special attention should be given to the very young women, as the early onset of endometriosis symptoms and a long delay in diagnosis may indicate the risk of an unfavorable course of the patient's medical and socio-medical history over time.