Anhedonia: The hidden psychological toll of deep endometriosis

The hidden toll of deep endometriosis: how chronic pelvic pain impacts pleasure, well-being, and mental health in affected women.

Study: Prevalence of anhedonia in women with deep endometriosis. Image Credit: Anhedonia: PeopleImages.com – Yuri A / Shutterstock

A study published in the journal Scientific Reports demonstrates the impact of chronic pain on pleasure sensitivity in patients with deep endometriosis.

Background

Anhedonia is a reduced ability to experience pleasure associated with social interactions and sensory stimuli. This condition is one of the most reliable behavioral endophenotypes for depression. It is also considered a transdiagnostic symptom in patients with mental disorders, such as schizophrenia and substance use disorders.

Besides reduced pleasure sensitivity, anhedonia is associated with a range of multifaceted reward-related deficits that involve complex psychological processes, including reward valuation, behavioral motivation, affective responses, and learning mechanisms.

A systematic network of dopamine-regulated mesocorticolimbic areas is known to regulate the impact and anticipation of hedonic experiences (pleasure experiences). Recent studies have identified the presence of anhedonia in patients with chronic pain and neurological diseases.

Endometriosis is a chronic gynecological condition characterized by the growth of endometrium-like tissue outside the uterus. It is frequently associated with chronic pelvic pain. The most severe form of the condition is deep endometriosis, which can disrupt the functionality of the urinary bladder, ureters, and bowel.

Regarding psychological impact, studies have found a considerably high prevalence of depression, anxiety, and bipolar disorders in patients with deep endometriosis. These mental disorders are considered to be associated with severe pelvic pain.

In this study, scientists have determined the prevalence of anhedonia in patients with deep endometriosis.

Study Design

The study included a total of 212 premenopausal women with suspected deep endometriosis who were receiving multidisciplinary treatment at a tertiary hospital. The mean age of participants was 40 years, and 64.8% were receiving hormonal treatments.

Anhedonia was measured using the gold-standard Snaith-Hamilton Scale, which covers four domains of hedonic experience: interests, social interactions, food or drink pleasure, and sensory experiences.

A composite measure was created by summing all deep endometriosis pain-related symptoms, including dyschezia (difficulty passing stool), dysuria (painful urination), dyspareunia (painful sexual intercourse), periovulation pain, dysmenorrhea (menstruation pain), and chronic pelvic pain.

Important Observations

The analysis of self-reported endometriosis symptom profiles revealed the presence of severe dysmenorrhea and fatigue in 75% of participants; menstruation-related gastrointestinal symptoms in 67% of participants; dyspareunia, periovulation pain, and abnormal uterine bleeding in 50% of participants; and dyschezia and chronic pelvic pain in 40% of participants. Participants with higher pain severity scores also reported significantly worse hedonic outcomes.

Prevalence of Anhedonia

The prevalence of anhedonia was 27.8% among women with deep endometriosis. A significant positive correlation of anhedonia was observed with at least five deep endometriosis pain-related symptoms, including dysuria, dyschezia, dyspareunia, pain during ovulation, and chronic pelvic pain. Specifically, chronic pelvic pain was identified as a significant predictor of anhedonia, with the odds of anhedonia increasing by 2.28 times when the pain was severe (95% CI: 1.12–4.23).

The severity of deep endometriosis pain-related symptoms showed a strong correlation with anhedonia. With a unit increase in the pain severity composite scale, the risk of having anhedonia increased by a factor of 1.05.

Psychological Impact

The study found significantly higher levels of anhedonia in patients with severe chronic pelvic pain compared to those without chronic pelvic pain. A similar pattern was observed for anxiety and depression, indicating that increased anhedonia is associated with a worse general mental condition.

Among the domains of hedonic experience, interests, social interactions, and food pleasure were identified as the most affected areas. This suggests a widespread impact of chronic pelvic pain on daily life pleasures. For example, sensory experiences and social withdrawal may be influenced by the interplay of inflammation and chronic stress, which are prevalent in endometriosis.

Study Significance

The study highlights the presence of anhedonia in nearly 30% of patients with deep endometriosis who are not diagnosed with mental disorders, including depression and anxiety. Anhedonia exhibits significant associations with the severity of deep endometriosis pain-related symptoms.

Moreover, the study finds that anhedonia is more pronounced in deep endometriosis patients with severe chronic pelvic pain. Overall, these findings highlight the strong impact of deep endometriosis and chronic pelvic pain on subjective hedonism.

Notably, the study demonstrates that anhedonia in patients with chronic pain disorders is not exclusively associated with a comorbid mental health disorder.

The highest impairment in nearly all studied domains of hedonic experience has been observed in deep endometriosis patients with severe chronic pelvic pain. This highlights the widespread impact of chronic pelvic pain on daily life pleasures.

However, the findings may be influenced by the widespread use of hormonal treatments in the study population, as 64.8% of participants were receiving such therapies. While these treatments are effective in reducing pain, they may also alter hedonic capacity, potentially limiting the generalizability of the results.

Overall, the study highlights overlooked consequences of deep endometriosis, which require further exploration. Future research should investigate specific therapeutic approaches aimed at improving hedonic functioning in this patient population.