E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedReviewed
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Prevalence of pain syndromes, mood conditions, and asthma in adolescents and young women with endometriosis.
Smorgick, Noam, Marsh, Courtney A, As-Sanie, Sawsan et al. · Journal of pediatric and adolescent gynecology · 2013 · DOI
Quick Summary
This study looked at young women (under age 24) with endometriosis to see how often they also experienced other pain conditions, mood problems, and asthma. Researchers found that more than half had multiple pain syndromes (like chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome), about half had depression or anxiety, and about a quarter had asthma. The study suggests these conditions often occur together in young women with endometriosis.
Why It Matters
Chronic fatigue syndrome (ME/CFS) is specifically listed as one of the pain syndromes in this study, and the high prevalence of comorbid conditions in endometriosis populations suggests shared pathophysiological mechanisms that may inform understanding of multisystem conditions like ME/CFS. The strong association between pain syndromes and mood conditions in this adolescent/young adult cohort highlights the importance of investigating central sensitization and neuroinflammatory pathways that may underlie both endometriosis and ME/CFS.
Observed Findings
56% (77/138) of adolescents and young women with endometriosis had comorbid pain syndromes (including chronic fatigue syndrome, fibromyalgia, IBS, chronic headaches, and others)
48% (66/138) had mood conditions (depression and/or anxiety)
26% (31/138) had asthma
Patients with comorbid pain syndromes were significantly more likely to report mood conditions (62% vs 30%, P<0.001) and smoking (31% vs 10%, P=0.003)
Patients with comorbid pain syndromes underwent more endometriosis surgeries (median 2 vs 1, P<0.005)
Inferred Conclusions
Comorbid pain syndromes, mood conditions, and asthma are highly prevalent in adolescents and young women with endometriosis
There is a strong bidirectional association between the presence of pain syndromes and mood disorders in this population
The presence of multiple comorbidities may correlate with disease severity or treatment complexity, as reflected by increased surgical intervention rates
Remaining Questions
Does endometriosis cause these comorbidities, or do they share a common etiology such as central sensitization, neuroinflammation, or genetic predisposition?
How do prevalence rates in endometriosis populations compare to age-matched controls without endometriosis?
What This Study Does Not Prove
This study does not establish causality or directionality—it cannot determine whether endometriosis causes these comorbidities, whether they share a common underlying mechanism, or whether they arise independently. The cross-sectional design and lack of a control group of endometriosis-free adolescents means we cannot determine if these comorbidity rates are elevated compared to the general population. The study does not explain biological mechanisms linking these conditions.
Tags
Symptom:PainFatigue
Phenotype:Pediatric
Method Flag:No ControlsSmall SampleWeak Case Definition
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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