Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015:3:2.
doi: 10.7243/2054-0841-3-2. Epub 2015 Jun 11.

Anxiety, coping skills and hypothalamus-pituitary-adrenal (HPA) axis in patients with endometriosis

Maria Quiñones  1 , Rebecca Urrutia  2 , Annelyn Torres-Reverón  3 , Katy Vincent  4 , Idhaliz Flores  5
Affiliations

Anxiety, coping skills and hypothalamus-pituitary-adrenal (HPA) axis in patients with endometriosis

Maria Quiñones et al. J Reprod Biol Health. 2015.

Abstract

Background: Endometriosis is an inflammatory disease that is defined by growth of endometrial tissue outside the uterus, resulting in pain, infertility, and emotional distress. Previous studies have shown that the HPA axis is compromised in patients with chronic, painful diseases, including endometriosis. However, the underlying mechanisms and the physiological and emotional consequences of dysfunctions in the HPA axis in these patients are largely unknown. We aimed to understand whether diurnal circulating cortisol levels in women with endometriosis are affected and how this impacts their emotional and behavioral responses.

Methods: Thirty-two patients with endometriosis and 36 healthy control women provided saliva samples and completed a series of psychological questionnaires. Salivary cortisol levels were measured in duplicate using a colorimetric immunoassay.

Results: There were significant differences in average cortisol levels between endometriosis patients and controls. A negative correlation was found between cortisol levels and infertility and dyspareunia. Furthermore, incapacitating pain was found to be a strong predictor of hypocortisolism. Women with endometriosis reported higher levels of trait anxiety, but showed no differences in perceived stress or in coping styles compared to the control group.

Conclusions: This study supports previous reports of hypocortisolism as a biomarker of aberrant HPA responses in women with endometriosis. Moreover, it provides further insight into the link between HPA axis dysregulation, emotional responses, and the high comorbidity between endometriosis and other inflammatory conditions.

Keywords: Endometriosis; HPA axis; anxiety; cortisol; infertility; pain.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A). Women with endometriosis (n=31) have lower levels of salivary cortisol than health controls (n=36). Bars represent means and standard deviation. (B). Using the Iterative Grubbs (alpha=0.05) two outliers were identified in the patients group. Comparisons were done using the Mann-Whitney non-parametric t-test. Statistical significance was set at p<0.05. *p=0.0195; **p=0.0033. (C). Cortisol levels were not significantly different in women with endometriosis currently on or off hormone therapy (e.g., oral contraceptives, GnRH agonists, Depo-Provera). Hormone Therapy (Tx) n=16; No hormone Tx n=15. Bars represent means and standard deviation. Comparisons were done using the Mann-Whitney non-parametric t-tests. Outliers not eliminated. Statistical significance was set at p<0.05. p=0.9301. (D). Cortisol levels had a tendency to be lower in women not currently receiving hormone therapy (e.g., oral contraceptives, GnRH agonists, Depo-Provera) compared to controls. Patients n=15; Controls n=15. Bars represent means and standard deviation. Comparisons were done using the Mann-Whitney non-parametric t-tests. Outliers not eliminated. Statistical significance was set at p<0.05. p=0.31.
Figure 2
Figure 2
Frequency of dyspareunia (always, almost always, almost never, never) (A) and perceived infertility (difficulty getting pregnant, Yes/No) (B) are significantly associated with salivary cortisol levels. Statistical differences were determined by Spearman rho correlations for A, and by Mann-Whitney non-parametric t-test for B. For this analysis the two outliers were excluded. Statistical significance was set at p<0.05.
Figure 3
Figure 3
Trait anxiety levels in women with (dark gray) and without (light gray) endometriosis. Women with endometriosis reported a higher score on the anxiety trait subscale (16 out of 29 who completed the survey; 57.1%) compared to controls (3 out of 36; 8.3%). As shown in this figure, a higher proportion of women with endometriosis reported anxiety as a trait. Differences in the trait anxiety subscale scores between groups were significant by Mann-Whitney non-parametric t-test (P<0.01).
See this image and copyright information in PMC

References

    1. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98:511–9. - PMC - PubMed
    1. Laudanski P, Szamatowicz J, Oniszczuk M. Profiling of peritoneal fluid of women with endometriosis by chemokine protein array. Adv Med Sci. 2006;51:148–52. - PubMed
    1. Lebovic DI, Mueller MD, Taylor RN. Immunobiology of endometriosis. Fertil Steril. 2001;75:1–10. - PubMed
    1. Bulun SE. Endometriosis. N Engl J Med. 2009;360:268–279. - PubMed
    1. Cramer DW, Missmer SA. The epidemiology of endometriosis. Ann N Y Acad Sci. 2002;955:11–22. - PubMed

LinkOut - more resources