Cognitive Functioning in Females with Endometriosis-Associated Chronic Pelvic Pain: A Literature Review.

Abstract

Objective: Cognitive complaints are commonplace among women living with endometriosis-associated chronic pelvic pain (CPP); yet, surprisingly few studies have assessed their cognitive functioning. As an initial step to address the resulting knowledge gap, this review aimed to synthesize the current literature reporting on cognition in females with endometriosis-associated CPP, and due to the poverty of endometriosis studies, to draw on data from female cohorts with other chronic pain conditions to gain potentially relevant insights.

Methods: Three database searches were conducted (Scopus, PubMed, and PsycINFO). Eighteen studies met the inclusion criteria (n = 8 regarding endometriosis, n = 10 regarding other chronic pain conditions).

Results: Six of the seven studies employing objective cognitive measures in females with other chronic pain reported significant cognitive deficits. Associated changes in neural circuitry thought to underpin these deficits align with neural patterns reported in females with endometriosis-associated CPP. While two studies reported a high prevalence (≥60%) of self-reported cognitive impairment in endometriosis-associated CPP, objective performance deficits have not been reported. Nonetheless, self-reported accounts of cognitive impairment suggest females with endometriosis-associated CPP may experience difficulties with inhibition, attention, and memory. Most studies did not control for potential moderating factors and comorbidities that prevail among endometriosis populations.

Conclusion: The field is in desperate need of research assessing cognitive performance in females with endometriosis-associated CPP, to objectively determine any cognitive difficulties. Attention should be paid to likely moderators, pain-related mechanisms, and whether findings extend to endometriosis without CPP.