Pain Anxiety Mental Health

Patients with suspected endometriosis reported distinct depression and…

Association between clinically suspected endometriosis lacking histologic evidence and anxiety, depression and cannabidiol-containing products.

European journal of obstetrics & gynecology and reproductive biology: X • • Relevant
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AI Summary

This clinic-based observational study examined whether patients with clinically suspected endometriosis but no histologic confirmation (CSENP) differed from patients with confirmed endometriosis and controls in depression, anxiety, and use of cannabinoid-containing products. It included 454 patients at a Los Angeles hospital. The main reported mental-health finding was that CSENP patients had higher adjusted odds of depression than patients with confirmed endometriosis (aOR 2.27, 95% CI 1.03–5.03). The abstract does not report a corresponding difference in anxiety.

Cannabis-use patterns also differed: controls were less likely than patients with endometriosis to report using cannabis for pain (aOR 0.32, 95% CI 0.16–0.64), while CSENP patients were more likely than patients with endometriosis to report using it for depression (aOR 1.92, 95% CI 1.01–3.65). These are observational associations, not evidence that cannabis treats pain or depression. As an abstract-based summary, the key limitation is that the study provides no product-dose information and cannot establish cause and effect; the authors also caution about possible long-term-use side effects.

💡 Key Findings

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In this clinic-based observational study of 454 patients, CSENP patients had higher adjusted odds of depression than patients with confirmed endometriosis (aOR 2.27, 95% CI 1.03–5.03).
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Compared with patients with endometriosis, controls were less likely to report using cannabis for pain (aOR 0.32, 95% CI 0.16–0.64).
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CSENP patients were more likely than patients with endometriosis to report cannabis use for depression (aOR 1.92, 95% CI 1.01–3.65); this association does not show that cannabis improves depression.
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The observational data lacked information on cannabinoid product dosage and cannot establish causation; the authors advise caution, including because of possible side effects of long-term use.
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📄 Original Abstract

Endometriosis is a common gynecologic condition, characterized by the growth of endometrial-like epithelial and stromal cells at ectopic sites, most commonly within the peritoneal cavity. Disease symptoms associate poorly with lesion burden, and severe symptoms of endometriosis can occur in patients in whom lesions cannot be detected by surgical inspection or pathologic examination of excised biopsies. Anxiety and depression are prevalent in patients with confirmed endometriosis. Additionally, recent evidence highlights an increasing prevalence of cannabinoid-containing products for management of pelvic pain. This study aimed to examine these comorbid traits and cannabinoid-containing products use in patients with "clinically suspected endometriosis with negative pathology" (CSENP). This study used data collected through The Biologic and Epidemiologic Markers of Endometriosis (BEME) clinic-based study at a quaternary hospital in Los Angeles, California. 454 patients were included. After multivariable regression analysis, CSENP patients were at higher risk of depression compared to confirmed cases [adjusted odds ratio (aOR) 2.27; 95% confidence interval (CI) 1.03-5.03, p = .043]. Compared with women with endometriosis, controls were less likely to use cannabis for pain (aOR 0.32, 95% CI 0.16-0.64). Compared with patients with endometriosis, CSENP patients were also more likely to use cannabis for depression (aOR 1.92, 95% CI 1.01-3.65). Even in the absence of histopathologic confirmation of lesions, patients with pain symptoms similar to those found in endometriosis have similar patterns of anxiety and depression which may require long-term management. Long-term follow-up of CSENP patients will be valuable to optimize the best strategies for clinical care. Data presented for cannabis use should be interpreted with caution due to the observational nature of the data, lack of information on dosage, and concerns about known side-effects of long-term use.

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