“Effortful” motherhood: A mixed-methods study of the impact of endometriosis on family life

Abstract

Endometriosis can significantly affect family and intimate relationships. This mixed-methods study examined the impact of endometriosis on family life, with a focus on parenting. Women completed an online survey including three open-ended questions, analysed using Template Thematic Analysis. Quantitative analyses included t-tests comparing parents and non-parents on mental health and social outcomes, and multiple regressions examining whether variables correlated to endorsement of themes. Fewer participants were parents compared with the general Australian population. Parents and non-parents reported comparable levels of pain and psychological distress. Parents reported greater friend support, while non-parents reported higher relationship satisfaction. Four themes were identified: early family planning influenced by medical advice; functional and emotional consequences for parents and children; challenges to romantic relationships; and ripple effects on family and social life. Pain severity predicted pre-conception impacts, and partner support predicted broader family and social effects, while psychological distress was unrelated to theme endorsement.

Keywords

endometriosis mixed methods motherhood family life

Introduction

Endometriosis is a chronic inflammatory condition in which endometrial-like tissue grows outside the uterus (Allaire et al., 2023), affecting 190 million women of reproductive age worldwide (World Health Organization, 2023). Women with endometriosis report severe pain, infertility, fatigue, heavy bleeding, and pain during sexual activity (Allaire et al., 2023). These symptoms are often severe enough to impair psychological well-being (Rempert et al., 2024), with reports of higher levels of depression and anxiety compared to healthy controls (Rempert et al., 2024), leading to substantially impaired quality of life (Rempert et al., 2024). With no known cure, endometriosis has significant and complex biopsychosocial consequences, often leaving those affected feeling as though their lives are controlled by the disease (Culley et al., 2013).

One of the most profound (van Stein et al., 2023) yet critically underexplored (Cole et al., 2021) aspects of endometriosis is its impact on intimate relationships and family dynamics. A recent systematic review and narrative synthesis of qualitative data from 22 studies highlighted that people with endometriosis commonly hold the perception that they are not fulfilling the expectations associated with their roles as partners, wives, and mothers, particularly when compared to women without the disease (Cunnington et al., 2024). Women with endometriosis often face difficulties such as infertility, maintaining intimate relationships, and managing the negative effects of the condition on household responsibilities and childcare (Missmer et al., 2021; van Stein et al., 2023).

The potential impact on fertility is a common and realistic concern (Navarria-Forney et al., 2020), as endometriosis is associated with an estimated fourfold infertility risk compared to the general population (Maggiore et al., 2024). Women who are not currently in relationships also face difficulties with fertility-related fears, including anxieties about finding a partner who understands the challenges the condition poses for family planning (Rush and Misajon, 2018). The inability to conceive or carry a pregnancy to term is often a stigmatizing experience (Kocas et al., 2023). The psychological burden of infertility is widely recognized, as it deeply affects mental health, leading to low self-esteem, sexual distress, depression, guilt, anxiety, frustration, and relationship challenges (Vitale et al., 2017).

A systematic literature review, comprising 10 studies, indicated that women with endometriosis report significant disruptions in sexual function and romantic relationships (Norinho et al., 2020). When they become parents, women with endometriosis also report that the disease limits family activities and impacts their children’s development (Fourquet et al., 2010; Moradi et al., 2014). A survey of 107 women diagnosed with endometriosis showed that among those with children, 45% reported that childcare-related activities were significantly affected (Fourquet et al., 2010), commonly leaving women feeling worthless and guilty (Hållstam et al., 2018). Despite increasing recognition of the effects of endometriosis on various life domains, including family life (Cole et al., 2021; Hållstam et al., 2018; Moradi et al., 2014), a focussed exploration of how the condition influences women’s roles as mothers and partners remains lacking.

Although the broader psychosocial impact of endometriosis has been increasingly documented (Cole et al., 2021; Rempert et al., 2024; Vitale et al., 2017), the specific ways in which endometriosis shapes family dynamics—particularly within parenting and intimate relationships—remain underexamined and require clearer articulation to justify focussed investigation. Prior qualitative studies have noted that endometriosis can disrupt family functioning, affect romantic relationships, and contribute to feelings of inadequacy in traditional roles such as motherhood and partnership (Cole et al., 2021; Cunnington et al., 2024; Fourquet et al., 2010; Hållstam et al., 2018; Norinho et al., 2020; van Stein et al., 2023). However, these aspects of life have typically been explored as secondary themes within broader investigations of quality of life or psychosocial well-being, rather than as central research foci (Cole et al., 2021; Moradi et al., 2014). Quantitative studies have also highlighted disruptions in sexual function and fertility-related distress (Maggiore et al., 2024; Norinho et al., 2020; Vitale et al., 2017), yet often lack the depth to capture the lived experience of family roles, family relationships, and day-to-day family functioning with endometriosis. To date, no study has comprehensively and specifically explored how endometriosis shapes women’s perceived roles as mothers and partners, nor how the condition influences broader family-system dynamics, particularly through a qualitative or mixed-methods lens that can illuminate the lived experiences behind functioning. The present study addresses that gap by placing family dynamics and family life at the centre of inquiry, using a mixed-methods approach to explore how women experience parenting and intimate relationships while living with endometriosis.

The present mixed-methods study aimed to understand how women experience endometriosis in the context of parenting and intimate relationships, with the overarching research question: How does endometriosis impact women’s family life? To support triangulation of the qualitative and quantitative data, it was hypothesized that quantitative measures of pain, psychological distress, and relationship and social support would be associated with qualitative themes about family life. Given the exploratory nature of these relationships, directional hypotheses were not offered. In addition, it was hypothesized that participants who were parents would show poorer mental health than non-parents.

Method

Design

The present study forms part of a broader longitudinal investigation examining wellbeing in women with dysmenorrhoea and endometriosis (Evans et al., 2021). The current analysis centres on qualitative data gathered during the third phase of data collection, conducted from July 4th to August 8th, 2021, where questions were asked about family life. This study received approval from the University Human Ethics Advisory Group (HEAG-H10_2019).

A critical realist approach was utilized, emphasizing that while research is influenced by the researchers’ perspectives, there remains an objective reality to be observed and described (Braun and Clarke, 2013; Sims-Schouten et al., 2007). Within this framework, a descriptive theoretical perspective was adopted, aiming to “summarize events in the everyday terms of those events” (Kim et al., 2017; Sandelowski, 2000). An inductive methodology was applied, where themes were created from the data.

The qualitative data for this study were collected online through three open-ended items that invited participants to provide short-text responses: (1) How has pelvic pain or endometriosis affected your ability and choice to become a parent?; (2) If you have children, please describe how pelvic pain or endometriosis has affected your parenting; and (3) What is the most significant impact of pelvic pain or endometriosis on your family life? Each item was optional for participants to complete.

Reflexivity statement

In conducting this study, it is essential to acknowledge the diverse perspectives and backgrounds of the contributors involved. The group included those with firsthand knowledge, such as individuals managing chronic health conditions, parents, and psychologists who frequently work with endometriosis patients, alongside researchers and methodologists offering an outsider perspective. This combination of expertise allowed for a multifaceted examination of the data, incorporating psychological, developmental, internal, and external perspectives, which significantly deepened the insights into the subject matter. The possibility of these perspectives shaping the research process—from data gathering to coding and analysis—was carefully considered and regularly discussed within the research team to ensure a balanced approach.

Recruitment

Recruitment was conducted through social media (Instagram and Facebook health groups), gym membership groups and university forums. Participants were directed to an online Qualtrics (2021) questionnaire where they were screened for study inclusion, asked to provide informed consent, and asked to complete a 30-minute survey. Participants were given the opportunity to win one of 10 $50 vouchers. The voucher incentive was a standard token-of-appreciation draw and was not tied to response content. It is therefore unlikely to have introduced systematic bias (Abdelazeem et al., 2022, 2023).

Participants

Eligible participants were women aged 18–50 residing in Australia who self-reported having experienced a period within the past 12 months.

Out of the 532 women who participated in the initial survey, 133 women identified as having endometriosis in the third wave of the survey (which asked about family life). Among them, over 95% reported receiving their diagnosis via laparoscopy or another surgery (n = 127; 95.49%), (others included ultrasound (n = 2), symptomatic assessment (n = 2), and other means (n = 2)).

Measures

Demographics

A demographic questionnaire was administered at both baseline and the 12-month follow-up. Certain variables, such as participant sex, marital status and ethnicity, were collected only at baseline, while information on variables such as employment and parous status was gathered at the follow-up survey.

Biopsychosocial measures

Depression, anxiety, and stress

Symptoms of depression, anxiety and stress were measured using the 21-item Depression Anxiety Stress Scales (DASS21; Lovibond and Lovibond, 1995). Items are rated on a 4-point scale (0 = did not apply to me at all, 3 = applied to me very much or most of the time). Subscale scores range from 0 to 21. Scores are categorized as mild to moderate within the following ranges: 5–10 for depression, 4–7 for anxiety, and 8–12 for stress. Scores above these indicate severe symptoms (Katz et al., 2025). The DASS21 has adequate construct validity and high reliabilities (Henry and Crawford, 2005).

Perceived relationship quality

Perceived relationship quality was assessed using a single item from the Perceived Relationship Quality Component Scale (Fletcher et al., 2000), rated on a 7-point scale (1 = not at all, 7 = extremely). With seven being indicative of the greatest level of relationship satisfaction. Prior research has demonstrated that this single-item measure can yield valid and reliable results (Niehuis et al., 2024).

Perceived social support

Perceived support from family, friends, and significant others was measured using the 12-item Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 1988a). Items are rated on a 7-point scale (1 = very strongly disagree, 7 = very strongly agree). Subscale scores are averaged (range: 1–7), with higher scores (5.1–7.0) reflecting greater perceived support (Zimet et al., 1988a). The MSPSS demonstrates good validity and reliability (Zimet et al., 1990).

Pain intensity

Pain intensity during menstruation (without pain medication) and sexual activity was assessed using 11-point NRS items (0 = no pain, 10 = worst pain possible). Pain severity was categorized as mild (1–4), moderate (5–7), or severe (8–10), consistent with previous approaches (Suvitie et al., 2016). The NRS has good construct validity and has been widely used to assess menstrual-related pain (Chen et al., 2015; Hawker et al., 2011).

Data analysis

Quantitative

Descriptive data were analysed using SPSS version 30 (IBM Corp, 2023). Independent samples t-tests assuming unequal variance compared the differences in symptoms of depression, anxiety, and stress among mothers and non-mothers. Further, independent samples t-tests assuming equal variance compared pain and social support between participants with children and without. A Z-test for proportions examined whether the proportion of individuals with children in the study sample differed significantly from that of the general Australian population. This test was chosen because it is most suitable for comparing proportions in large samples (Wooditch et al., 2021).

To identify whether psychological, pain-related, or social factors predicted endorsement of the qualitative themes, we conducted three multiple linear regression analyses corresponding to Theme 1 (pre-conception impacts), Theme 2 (parenting impacts), and Theme 4 (broader family and social impacts). Each theme’s endorsement score served as the dependent variable. Correlates included pain intensity during menstruation, mental health symptoms (DASS-21 depression, anxiety, and stress subscale scores) and perceived social support (MSPSS Significant Other, Friends). Theme 3 (romantic relationship impacts) was not analysed due to a lack of variance, as all participants reported some level of impact. All assumptions for linear regression (linearity, independence, homoscedasticity, normality of residuals, and multicollinearity) were examined and met.

Qualitative

A 6-step process of template thematic analysis (Brooks et al., 2015) was employed: (1) the researchers began by familiarizing themselves with the data through repeated readings of the transcripts; (2) initial hand coding was performed; (3) themes were organized into clusters for further analysis; (4) a coding template was created, incorporating both newly identified and pre-established themes; (5) the template underwent iterative refinement, incorporating feedback from team members and adjusting coding labels and template structure until a final version was reached; (6) the final template was applied to code the entire dataset. The coding was conducted using Nvivo (Jackson and Bazeley, 2019). The final list of themes was derived through team discussions. Content analysis was then conducted by computing frequency counts for the primary themes related to healthcare impact, symptoms, and daily functioning. Sub-themes were illustrated with participant quotes to provide context. Even responses from one or two participants can provide valuable insights for improving clinical care (Karnieli-Miller et al., 2009), and emphasis was placed on experience expressed by words, rather than numbers.

Results

Demographic information is presented in Table 1. All participants identified as female, with an average age of 35.56 years (SD = 10.56) at the time of survey completion. Overall, 3.76% identified as Aboriginal or Torres Strait Islander. The majority were married or in a de facto relationship (54.98%) and worked full-time (51.88%). Most participants did not have children (66.92%) and did not use the contraceptive pill (74.44%). The proportion of individuals with children in the study sample (33%) was significantly lower than that in the general Australian population (61%; Australian Institute of Family Studies, 2023), as indicated by the Z-test for proportions (Z = −6.86, p < 0.01). However, for women aged 20–29 years, the proportion of mothers in the study sample (13%) was not significantly different from the general Australian population (20%; Z = −1.33, p = 0.18; Statistics; Tables 2 and 3).

Table 1.

Sociodemographic and health-related characteristics of participants.

Characteristic	M (SD)	n (%)
Age (years)	35.56 (10.56)
Female^a		133 (100.00)
Relationship status^a
Single (never married)		53 (39.85)
Married/de facto		73 (54.89)
Divorced		4 (3.01)
Separated		1 (0.75)
Other		2 (1.50)
Aboriginal or Torres Strait Islander^a		5 (3.76)
Ethnicity(s)^a
English		112 (84.21)
European		34 (25.56)
Chinese		1 (0.75)
Indian		1 (0.75)
Other Asian		4 (3.01)
Level of education^a
Less than year 12		3 (2.26)
Year 12 or equivalent		23 (17.29)
Vocational education (TAFE)		31 (23.31)
Bachelor’s degree		50 (37.59)
Master’s degree		17 (12.78)
PhD/doctorate		1 (0.75)
Other		8 (6.02)
Employment status
Employed		105 (78.95)
Unemployed		9 (6.77)
Student		7 (5.26)
Other		12 (9.02)
Children
Yes		44 (33.08)
No		89 (66.92)
Method of diagnosis
Laparoscopy/other surgery		127 (95.49)
Ultrasound		2 (1.50)
Symptomatic assessment		2 (1.50)
Other		2 (1.50)
Contraceptive pill
Yes		34 (25.56%)
No		99 (74.44%)

Data collected at baseline.

Table 2.

Comparison between participants with children and without for mental health, pain, and social support variables.

Variable	Group	M (SD)	T	df	p
Depression	Mothers	11.74 (9.63)	−1.57	121	0.12
Depression	Non-mothers	14.86 (10.53)
	Total sample	13.87 (10.31)
Anxiety	Mothers	11.08 (8.12)	0.18	121	0.86
Anxiety	Non-mothers	10.79 (8.76)
	Total sample	10.88 (8.53)
Stress	Mothers	18.36 (8.87)	−0.10	121	0.92
Stress	Non-mothers	18.55 (9.83)
	Total sample	18.49 (9.50)
Menstrual pain	Mothers	6.55 (1.78)	−1.82	131	0.07
Menstrual pain	Non-mothers	7.11 (1.64)
	Total sample	6.92 (1.70)
PDSA	Mothers	4.73(2.62)	−0.41	130	0.68
PDSA	Non-mothers	4.92 (2.53)
	Total sample	4.86 (2.55)
Relationship satisfaction*	Mothers	4.55 (1.61)	−2.29	111	0.02*
Relationship satisfaction*	Non-mothers	5.31 (1.68)
	Total sample	5.05 (1.68)
PSS family	Mothers	5.53 (1.35)	1.67	111	0.10
	Non-mothers	5.00 (1.70)
	Total sample	5.18 (1.60)
PSS friends*	Mothers	5.69(0.99)	1.95	111	0.05*
	Non-mothers	5.19 (1.41)
	Total sample	5.36 (1.30)
PSS others	Mothers	5.92 (1.03)	0.52	111	0.61
	Non-mothers	5.80 (1.34)
	Total sample	5.84 (1.24)

PDSA: pain during sexual activity, PSS: perceived social support.

p ⩽ 0.05.

Table 3.

Variables associated with theme endorsement.

Theme 1: Endometriosis can affect family life from before conception
Correlate	B	SE	Beta	t	p	95% CI lower	95% CI upper
Pain level	0.078	0.035	0.247	2.197	0.031*	0.007	0.149
DASS21 stress	−0.004	0.009	−0.086	−0.479	0.633	−0.021	0.013
DASS21 depression	0.003	0.006	0.072	0.506	0.614	−0.009	0.015
DASS21 anxiety	0.007	0.009	0.132	0.826	0.411	−0.011	0.025
PSS significant other	0.086	0.071	0.231	1.207	0.231	−0.056	0.228
PSS friends	0.081	0.064	0.229	1.265	0.209	−0.046	0.208
Theme 2: Parents and children experience functional and emotional consequences
Pain level	0.04	0.038	0.185	1.042	0.308	−0.039	0.118
DASS21 stress	0.013	0.011	0.303	1.12	0.274	−0.011	0.037
DASS21 Depression	0.00005	0.009	0.001	0.005	0.996	−0.019	0.019
DASS21 Anxiety	−0.003	0.011	−0.059	−0.253	0.803	−0.025	0.02
PSS significant other	−0.201	0.134	−0.547	−1.501	0.146	−0.478	0.075
PSS friends	0.018	0.099	0.05	0.183	0.856	−0.187	0.223
Theme 4: Ripple effects on family functioning and social connections
Pain level	0.044	0.064	0.152	0.694	0.495	−0.088	0.177
DASS21 stress	−0.016	0.015	−0.333	−1.03	0.314	−0.048	0.016
DASS21 depression	0.003	0.01	0.063	0.29	0.774	−0.018	0.023
DASS21 anxiety	0.016	0.015	0.335	1.104	0.282	−0.014	0.046
PSS significant other	0.32	0.12	1.096	2.66	0.014*	0.071	0.57
PSS friends	0.197	0.14	0.676	1.409	0.173	−0.093	0.487

DASS21: 21-Item Depression Anxiety Stress Scales; PSS: perceived social support.

p ⩽ 0.05.

Participants reported moderate menstrual pain and mild to moderate pain during sexual activity. They also reported severe symptoms of depression, anxiety, and stress. Despite this, they described relatively high relationship satisfaction and positive perceptions of social support from family, friends, and significant others.

There were no significant differences between participants with and without children in reported pain during menstruation and sexual activity without the use of pain medication. Similarly, no significant differences were found in symptoms of depression, anxiety, and stress, or in perceived social support from family and significant others. However, participants with children reported significantly greater social support from friends compared to those without children. In contrast, participants without children were significantly more satisfied in their relationships than those with children.

Qualitative themes

Four themes were identified, illustrating the impact of endometriosis on family life, ranging from the pre-conception stage to parenting, romantic relationships, and within and beyond the nuclear family network. Figure 1 shows an overview of themes and subthemes. Table 4 presents a summary of themes, subthemes and supporting quotes. It also includes the number of participants whose responses were classified under each subtheme, as well as the total number of participants who experienced the impact described by the theme. Participants were identified by their age and parental status to provide context for their responses.

Figure 1.

Overview of qualitative themes and subthemes illustrating the impact of endometriosis on family life.

Table 4.

Themes, sub-themes and illustrative quotes.

Theme	Sub-theme	Illustrative quotes	Total^a (%)
1. Endometriosis can affect family life from before conception			62 (46.6)
	No impact to date	“I was told that I would have problems conceiving and did have IVF booked in but found out I was with child 2 weeks before our appointment. Became pregnant within a year of beginning to try so it was clearly not as problematic as I was led to believe.” 48 years old, mother.	33 (24.9)
	No impact to date	“I thought for a long time that conception would be difficult, but my diagnosis shows that I am unlikely to have difficulties in that regard.” 21 years old, non-mother.	33 (24.9)
	Early Family Planning Decision-Making Influenced by Medical Advice	“I became a mum much earlier than I would have liked because I was told that I needed to try "now or never" at 20. I don’t regret my decision, obviously, but I do feel it was out of my hands.” 35 years old, mother.	9 (6.8)
		“Some of them were real quacks and advised me to have unprotected sex and get pregnant then have a late term abortion to “reset” my hormones (which they didn’t test) for treatment of my symptoms.” 37 years old, non-mother.
		“I started having children earlier than I would have, out of fear of infertility.” 47 years old, mother.
	Pain and infertility derail parenthood plans	“It has impacted my plans for children, as I need an IUD just in order to function as a human. I become afraid when I think about the possibility of taking the IUD out and having to go through months of agony only to discover I may be infertile, and all the pain was a waste.” 24 years old, non-mother.	23 (17.3)
		“It seems the choice is out of my hands–I still greatly want to become a parent, but it seems more unlikely that I won’t be able to. This has been a great source of depression and heartbreak for me.” 32 years old, non-mother.
		“I’m not sure if I want kids as I’m scared, I’ll have a girl and pass it on to her. Plus, I’m worried I won’t be able to have kids because of endo.” 42 years old, non-mother.
	Challenges in conception	“I am medically infertile after having had my right ovary and both Fallopian tubes removed. We have had 1 round of IVF with no success. We are unsure if we will try another round due to financial, mental & physical reasons.” 34 years old, non-mother.	37 (27.9)
		“I’m very fortunate to manage having 1 healthy and beautiful child, but due to endometriosis, and how late in my life I was diagnosed and treated, our dream of a bigger family wasn’t possible.” 49 years old, mother.
		“We have been TTC for 8 years, had 5 miscarriages from natural pregnancies and have been doing IVF for 3 years–5 egg collections, 5 transfers with no success.” 42 years old, non-mother.
2. Parents and children experience functional and emotional consequences			28 (21.0)
	No impact	“It hasn’t. Being a parent is the most important thing to me.” 42 years old, mother.	5 (3.7)
	No impact	“It hasn’t.” 30 years old, mother.	5 (3.7)
	Challenges in parenting	“I’m not present as a parent when I am in pain and cannot function.” 45 years old, mother.	28 (21.0)
		“It’s hard. I can’t bend to hug them in bed, kiss them goodnight.” 35 years old, mother.
		“I feel like a useless parent when I’m unable to function and be happy when in pain.” 47 years old, mother.
	When children witness parental suffering	“2 surgeries when my son was young was difficult to recover properly from, 2 surgeries when my daughter little was traumatic for her seeing me in hospital and in pain but missing special school kinder events due to recovery or pain.” 42 years old, mother.	4 (3.0)
		“They are hyper aware of period days and are extremely tolerant. If I could parent them without pain interference, there would be a lot less screen time. We’d be outdoors in the garden all day.” 33 years old, mother.
		“I can’t do anything I love. I’m quick to anger and I’m worried I’m raising kids who are anxious about my mood. That thought terrifies me. I can’t go on walks with my kids. I’m a gardener, but I can barely do anything because of this horrific disease. And the worst part is knowing it will never change.” 35 years old, mother.
3. Endometriosis Dampens Romantic Relationships			18 (13.5)
	Strain on sexual intimacy	“My sexual life became a disaster because of the pain and discomfort.” 49 years old, mother.	13 (9.8)
		“My sex life is ruled by pain and discomfort.” 27 years old, non-mother.
		“I’m a 27yr old virgin because it’s too painful to have anything up there let alone sex so anatomically is impossible right now.” 27 years old, non-mother.
	Challenges in forming and sustaining empathetic partnerships	“The mood swings, low libido etc contributed to the end of my long-term relationship, plus, along with PCOS meant I we didn’t get pregnant.” 48 years old, non-mother.	4 (3.0)
		“Broke down my relationship and worry about painful sex doesn’t make me confident in entering a new one.” 48 years old, non-mother.
		“I feel that I have to almost put my relationships into a ’rush’ as my fertility may be affected. I’ve had partners that have not believed that I had endometriosis that has impacted on my mental health.” 32 years old, non-mother.
	Shifting domestic and caregiving roles	“When I cannot get out of bed and my husband has to do everything.” 45 years old, mother.	2 (1.5)
4. Ripple Effects on Family Functioning and Social Connections			23 (17.3)
	No impact	“I am lucky as I have been able to continue daily activities through any pelvic pain, so no real impact I can think of.” 50 years old, mother.	9 (6.8)
	No impact	“No impact” 38 years old, mother.	9 (6.8)
	Disruptions in daily living and household management	“I sometimes struggle to do household chores.” 24 years old, non-mother.	9 (6.8)
	Disruptions in daily living and household management	“Inability to work or do basic household tasks like lift washing or heavy plates.” 27 years old, non-mother.	9 (6.8)
	Shifts in social engagement and relationship strain	“There are multiple days though out the year where I have to cancel plans with family and friends as I’m in too much pain to do anything.” 42 years old, non-mother.	15 (11.3)
		“Mood swings can make life unpleasant for others especially when I am really weepy.’ 51 years old, mother.
		“Unable to look after Mum as well as I’d like to.” 37 years old, non-mother.
		“They are sick of me being in pain and don’t understand why I can feel sick so often.” 27 years old, non-mother

This shows how many participants endorsed each theme and subtheme. Since one participant can contribute to multiple subthemes, their counts may exceed the total for the main theme.

Theme 1: Endometriosis can affect family life from before conception

One of the main effects of endometriosis was its impact on conception and family planning.

Early family planning decision-making influenced by medical advice

Some participants (6.8%) commented that they had to confront the decision-making stage of family planning much earlier than anticipated, in part due to their own concerns for being able to have children in the future, and in part because they were alerted to potential fertility challenges by medical professionals.

One participant shared she had received medical advice to become pregnant and then have a late term abortion, to “reset” her hormones as an effective treatment for endometriosis. She described them as “real quacks,” illustrating her recognition of having received medical misinformation, and highlighting the need for practitioners to respect women’s bodies by engaging in evidence-based care and understanding the physiological and psychological impacts of their medical advice.

Pain and infertility derail parenthood plans

Participants who had not yet had children shared their concerns about becoming pregnant (17.3%), which were multifaceted and extensive. For example, it was clear that some women were afraid of not being a present parent due to the interference of endometriosis, denoting a lack of parenting confidence. Others were worried about their endometriosis symptoms increasing during pregnancy and passing their condition on to their children.

Challenges in conception

Participants commented on their difficulties in becoming pregnant, including requiring fertility treatments, not being able to have their desired number of children, facing repeated miscarriages, or being unable to conceive (27.9%). Some participants mentioned that they would be unable to conceive since hormonal treatment was needed for them to function in their daily lives. Similarly, many participants who were considering parenthood were worried about the possibility of finding out they were infertile.

A quarter (24.9%) of women who answered questions about conception reported that endometriosis had not affected their choice or ability to become a parent. Among them, some never intended to have children, regardless of their endometriosis.

Theme 2: Parents and children experience functional and emotional consequences

About one-third of the participants in our sample were parents (33.08%). Mothers with endometriosis shared that the consequences of the disease were not limited to their own experience but extended to their children and the parent/child bond.

Challenges in parenting

Mothers consistently described parenting with endometriosis as effortful, emphasizing how the condition limited their physical and mental participation in their child’s life (21.9%). Some expressed self-criticism and self-blame, perceiving their reduced capacity to be present, as a personal failure and describing feelings of uselessness. Others highlighted the difficulty of maintaining a calm and positive demeanour, particularly while in pain, noting that they became more irritable and short-tempered. As a result, some questioned their effectiveness as parents.

Moreover, mothers’ concerns extended beyond parenting itself. Some worried about the impact of endometriosis on the mother-child bond, their child’s development, and, for those with daughters, their potential experience of endometriosis and painful menstruation.

When children witness parental suffering

A concern for participants (3.0%) was that their children witnessed their suffering. Children saw their parents experience pain, undergo surgeries, and spend time in the hospital. Additionally, parents spoke about the limitations on their ability to be as present as they would like with their children—such as needing to withdraw due to pain, being unable to attend school or kinder events, or not being able to bend down to provide physical affection. Parents also expressed concerns about their children “missing out on life.” One parent described how their children were outdoors less and spent more time on screens as a consequence of that parent’s endometriosis.

A small portion of mothers (3.7%) claimed that endometriosis had no significant impact on their parenting or family life, including their children.

Theme 3: Endometriosis is a source of struggle for romantic relationships

Strain on sexual intimacy

Participants (9.8%) described endometriosis as a significant barrier to a fulfilling sexual life. Persistent pain often made sexual intimacy challenging, and for some, impossible, affecting both enjoyment and self-esteem. This not only strained relationships but also left women feeling deeply frustrated, deprived of the intimacy they want to enjoy. Additionally, the severity of the pain was such that one participant reported never having had intercourse due to vaginal discomfort.

Challenges in forming and sustaining empathetic partnerships

Participants highlighted the difficulties in finding and maintaining relationships with partners who truly understand and support the challenges of endometriosis (3.0%). The condition’s associated mood swings, low libido, and other symptoms can strain relationships and lead to their dissolution.

Furthermore, concerns about fertility and the pressure to start a family can create a sense of urgency and anxiety in forming new relationships, as individuals may feel forced to prioritize reproductive concerns over personal connexion, which can impact their emotional well-being and relationship dynamics.

Shifting domestic and caregiving roles

Another consequence of endometriosis in romantic relationships was the increased reliance on partners for managing household and parenting duties. When symptoms are severe, one partner may need to assume a larger share of responsibilities, which can alter relationship dynamics.

Theme 4: Ripple effects on family functioning and social connections

Participants (17.3%) described how endometriosis affected their ability to manage household tasks and daily activities, with impacts extending beyond the home to broader social networks.

Disruptions in daily living and household management

Participants shared that they struggled to complete household chores and everyday tasks or have to stop, often due to pain and fatigue (6.8%). Some noted that their partners were required to compensate and do more as a consequence.

Shifts in social engagement and relationship strain

Participants spoke about significant changes in their wider social lives as a result of their experience with endometriosis (11.3%). They described difficulties committing to social events and gatherings, needing to suddenly withdraw due to symptom flare-ups, or declining invitations, which meant missing out.

Other participants mentioned a lack of understanding from people in their social networks about their condition and its impacts. Some also expressed concern about the impact on others in their social networks. Participants described how some of their relationships eroded due to their limited ability and willingness to engage socially. They also explained how the disease made it difficult for them to meet new people. Furthermore, a minority (6.8%) of participants reported endometriosis not having significant impacts on their family functioning and social connections.

Discussion

This study aimed to explore the experiences of women with endometriosis in the context of parenting and intimate relationships. Correlational analysis showed limited explanatory power, with pain severity emerging as the only significant predictor for one family-life theme and perceived partner support uniquely predicting broader ripple effects on family and social functioning. Psychological distress (depression, anxiety, stress) and friend support were not associated with endorsement of any themes, indicating that these qualitative impacts are largely independent of mental health symptom severity. Furthermore, our sample reported severe symptoms of depression, anxiety, and stress, with no mental health differences between parents and non-parents. This suggests that the psychological burden of endometriosis is pervasive and not uniquely linked to parenting status. However, qualitative findings revealed nuanced challenges for parents, including difficulties in conception (27.9%), early family planning influenced by medical advice (6.8%), and parenting struggles such as reduced physical/mental participation in children’s lives (21.9%) and concerns about children witnessing parental suffering (3.0%). Participants also described strain on romantic relationships due to sexual intimacy barriers (9.8%) and shifts in caregiving roles. The lack of difference may reflect the overarching impact of chronic pain and illness on mental health, which can affect individuals with endometriosis regardless of parental role (Evans et al., 2007; Sirohi et al., 2023). These findings highlight that while parenting introduces distinct relational and practical challenges—such as disrupted family functioning (17.3%) and social engagement (11.3%)—the core psychological toll of endometriosis remains consistent across groups. Moreover, mental health symptoms (depression, anxiety, and stress) did not predict endorsement of any qualitative themes, supporting the interpretation that the impacts described by participants are not simply reflections of underlying psychological distress. Instead, the themes appear to reflect broad, shared lived experiences of navigating endometriosis in the context of family life, regardless of individual differences in mental health.

Participants expressed that the impacts of endometriosis on their parenting journey were multifaceted and evident even before conception. For instance, family planning often began earlier than anticipated, driven by women’s fear of infertility—a fear four times more prevalent in those with endometriosis than in the general population (Maggiore et al., 2024)—and medical advice to conceive as early as possible, a recommendation also documented in previous research (Kocas et al., 2023; Missmer et al., 2021; van Stein et al., 2023). Worryingly, one participant shared that their doctor recommended her to become pregnant and have a late-term abortion as a treatment for endometriosis.

Participants described profound challenges around conception, including reliance on hormonal treatments, infertility, pregnancy complications, and unmet family planning goals. These experiences exacerbated psychological distress—manifesting as depression, grief over lost reproductive autonomy, and strain on intimate relationships (Kocas et al., 2023; Missmer et al., 2021; van Stein et al., 2023; Vitale et al., 2017). Our quantitative findings showed that only 33% of participants had children—a significantly lower rate than that of the general Australian population (61%; Australian Institute of Family Studies, 2023), providing numerical support for these reproductive barriers. However, among younger women (20–29 years), the proportion with children (13%) approached population norms (20%; Statistics), suggesting age-modified effects. Notably, menstrual pain severity significantly predicted endometriosis’s impact on family planning and conception, aligning with participants’ qualitative accounts of how physical symptoms shaped early family-planning decisions, concerns about infertility, and reproductive autonomy.

Following conception and the birth of children, participants highlighted how endometriosis affected their roles as mothers. Many mothers described parenting with endometriosis as “effortful,” aligning with prior findings that 45% of women with the condition report significant disruptions in childcare (Fourquet et al., 2010). Some questioned their own effectiveness as parents, criticizing themselves for not being mentally and physically present enough in their children’s lives. They cited reduced capacity to hug and play with their children, missing out on school events, spending less time outside with their children, and increased screen time as specific concerns. Many worried about a weakened mother-child bond and the emotional impact on their children of witnessing their suffering. These concerns are supported by research on maternal chronic pain, which shows that children of mothers with chronic pain exhibit higher levels of internalizing behaviours (e.g. anxiety, depression), externalizing behaviours (e.g. aggression), and insecure attachment compared to children of pain-free mothers (Evans et al., 2007, 2018). Some mothers also feared their children might inherit endometriosis, adding to their psychological distress. This fear was intensified by evidence showing that children of people with chronic pain are more likely to experience pain and psychological difficulties themselves (Evans et al., 2007, 2018). No correlates were associated with reported effects on theme number 2: “Parents and children experience functional and emotional consequences” echoing participants’ qualitative reports that parenting challenges cut across pain levels, mental health profiles, and social support, reflecting a widespread impact of endometriosis on day-to-day parenting roles rather than one driven by specific biopsychosocial factors.

Interestingly, while parents and non-parents reported similar levels of depression, anxiety, and stress, parents noted significantly greater social support from friends compared to non-parents. This is consistent with parenting literature highlighting the role of peer networks in buffering caregiving strain (Gudka et al., 2023; Power et al., 2011). However, participants without children reported higher relationship satisfaction, which aligns with studies showing that parenting—particularly under conditions of chronic illness—can place additional strain on romantic relationships (Monin et al., 2019). The dual burden of managing a chronic ailment and parenting may intensify feelings of guilt (Parton et al., 2019), reduce couple intimacy (Shahhosseini et al., 2014), and heighten role overload (Bar and Jarus, 2015), all of which have been linked to lower relationship quality in previous research (Weitkamp et al., 2021).

Quantitative data revealed mild to moderate sexual pain for participants, yet paradoxically high relationship satisfaction and perceived partner support, suggesting that some couples develop adaptive strategies despite sexual challenges. Meanwhile, qualitative results suggest others struggled to form new relationships, feeling pressured to commit quickly to align with medical advice to conceive early. Partners often assumed greater household and parenting responsibilities, reflecting the reshaped dynamics of romantic partnerships described in previous research (Norinho et al., 2020).

Intimate relationships were another challenge, with participants describing how pain during sex—a hallmark symptom (Allaire et al., 2023)—ranged from disruptive to wholly prohibitive, exacerbating relationship tensions, and, in some cases, making them difficult to initiate and maintain. One participant shared she had never been able to have intercourse due to pain, underscoring the severe sexual dysfunction documented in endometriosis (Norinho et al., 2020).

Beyond their nuclear families, participants described how endometriosis eroded their social lives, causing them to withdraw from social commitments and events. Moreover, greater perceived support from a significant other predicted stronger endorsement of endometriosis’s effects on family functioning, suggesting that those who experience wider relational or social disruptions may also lean more heavily on partner support, as evidenced by previous research (Checton et al., 2015; Rees et al., 2001). This complements qualitative descriptions of partners taking on additional caregiving and household responsibilities and providing emotional support during flare-ups or medical interventions. Despite quantitative results reporting strong perceived support from friends and family, qualitative accounts also revealed persistent social disconnection and a sense that their condition and its impacts were not fully understood. This experience aligns with the under-recognition and stigma surrounding the condition found in previous studies (Allaire et al., 2023). This finding underscores that even robust support networks may not fully mitigate the activity limitations imposed by chronic illness symptoms. While social support can enhance participation in daily activities, it does not always compensate for the functional limitations experienced by individuals with chronic conditions. For instance, a 2018 study found that adults with chronic illnesses often face restricted social engagement despite having support networks, highlighting the need for tailored interventions to address these limitations (Meek et al., 2018). Some participants in the present study struggled to maintain friendships or forge new connections, leaving them increasingly isolated—a stark contrast to the protective role stable relationships can play in mental health (Facchin et al., 2017).

Strengths and limitations

It is necessary to consider the study’s findings in the context of possible limitations. While large for a qualitative study, many responses provided by participants were short and thus our interpretation is limited by thin data with the need for further in-depth interviews. The use of short, open-ended questions may also have encouraged brief or yes/no-style responses, thereby limiting data richness. Additionally, online data collection may have introduced sampling biases, as individuals without internet access or who are less engaged online may be under-represented.

Despite these limitations, the study also presents several significant strengths. The sample encompassed individuals of various life circumstances (i.e. age, education level, parenting status), which can enhance the transferability of the findings to different populations within the same cultural context. Furthermore, the inclusion of individuals with varying levels of endometriosis symptom severity, mental health and social well-being provided a comprehensive understanding of the conditions across its spectrum, thereby offering a more nuanced perspective on its impacts.

In-depth qualitative research is essential to further document the lived experiences of women navigating endometriosis in the context of parenting. Richer qualitative data would allow for a deeper understanding of the nuanced and evolving ways the condition affects family life. Similarly, future research should attempt to include more culturally diverse samples in order to understand how the effects of endometriosis can vary in different contexts.

Clinical implications

The key clinical implications include the need to adopt a biopsychosocial approach to mitigate the multifaceted impacts of endometriosis. Integrating mental health support, listening to patients’ lived experiences, and collaborating across disciplines are critical steps towards improving care for women with endometriosis.

Furthermore, it is imperative to challenge medical misinformation, particularly around fertility counselling, ensuring it is evidenced-based and avoiding alarmism. Moreover, clinicians should acknowledge the psychological toll of the fertility aspect of endometriosis and strive to integrate mental health support to address grief, anxiety and relationship strain. Additionally, it is critical that the challenges in parenting faced by women with endometriosis and chronic conditions be considered by their medical providers, screening for mental health issues and providing appropriate support. Similarly, clinicians should be proactive in addressing sexual health, as it is a significant concern for many patients.

Finally, it is imperative that medical practitioners familiarize themselves with the complex challenges women with endometriosis face in starting and maintaining families and intimate relationships. Greater awareness of these lived experiences is essential to providing high-quality, person-centred care that addresses not only physical symptoms but also the psychological and social dimensions of the condition.

Conclusion

This study showed that endometriosis can and does have an impact that extends beyond the patient and affects their families as well. Despite reporting high relationship satisfaction via quantitative data, participants described compounding challenges across various aspects of family life, including conception, motherhood and parenting, sexual intimacy and romantic relationships, and broader social networks. The regression analyses further demonstrated that these family-life impacts were not necessarily associated with mental health symptom severity; instead, menstrual pain predicted pre-conception impacts, and partner support predicted broader family and social disruptions. Taken together, these findings underscore that endometriosis reshapes family life through physical, relational, and social pathways that are not adequately captured by psychological distress alone, highlighting the need for family- and couple-informed approaches to care and research.

Footnotes

ORCID iDs

Yao Coitinho Biurra

Subhadra Evans

Ethical considerations

This study received approval from the University Human Ethics Advisory Group (HEAG-H10_2019) and in Australia from the Deakin University Human Ethics Advisory Group (HEAG-H10_2019). This manuscript complies with ethical standards for academic publishing. It is original, properly cited, and free from plagiarism or other forms of misconduct. All authors have approved the content and consent to its submission.

Consent to participate

All participants provided informed consent to participate in the study.

Consent for publication

Participants provided consent to participate in this study and for their anonymised data to be published.

Author contributions

Yao Coitinho Biurra: Conceptualisation, methodology design, data analysis, manuscript drafting and revision. Jessica Bowring: Initial data preparation, data analysis, manuscript drafting and revision. Luanna dos Santos Silva: Initial data preparation, data analysis, manuscript drafting and revision. Antonina Mikocka-Walus: Study design consultation, manuscript revision. Subhadra Evans: Conceptualisation, study supervision, final manuscript editing

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Qualitative data will not be made available due to confidentiality concerns. De-identified quantitative data underlying the reported findings may be made available upon request to qualified researchers for non-commercial academic use, beginning 12 months after publication and for up to 3 years. Requests should be directed to the corresponding author.

References

Abdelazeem

Abbas

Amin

, et al. (2022) The effectiveness of incentives for research participation: A systematic review and meta-analysis of randomized controlled trials. PLoS One 17: e0267534.

Abdelazeem

Hamdallah

Rizk

, et al. (2023) Does usage of monetary incentive impact the involvement in surveys? A systematic review and meta-analysis of 46 randomized controlled trials. PLoS One 18: e0279128.

Allaire

Bedaiwy

Yong

(2023) Diagnosis and management of endometriosis. CMAJ: Canadian Medical Association Journal 195(10): E363–E371.

Australian Institute of Family Studies (2023) Families and family composition. Available at: https://aifs.gov.au/research/facts-and-figures/families-and-family-composition (accessed 6 February 2025).

Bar

Jarus

(2015) The effect of engagement in everyday occupations, role overload and social support on health and life satisfaction among mothers. International Journal of Environmental Research and Public Health 12(6): 6045–6065.

Braun

Clarke

(2013). Successful qualitative research: A practical guide for beginners. London: Sage.

Brooks

McCluskey

Turley

, et al. (2015) The utility of template analysis in qualitative psychology research. Qualitative Research in Psychology 12(2): 202–222.

Checton

Magsamen-Conrad

Venetis

, et al. (2015) A dyadic approach: Applying a developmental-conceptual model to couples coping with chronic illness. Health Education & Behavior 42(2): 257–267.

Chen

Kwekkeboom

Ward

(2015) Self-report pain and symptom measures for primary dysmenorrhoea: A critical review. European Journal of Pain 19: 377–391.

10.

Cole

Grogan

Turley

(2021) “The most lonely condition I can imagine”: Psychosocial impacts of endometriosis on women’s identity. Feminism & Psychology 31(2): 171–191.

11.

Culley

Law

Hudson

, et al. (2013) The social and psychological impact of endometriosis on women’s lives: A critical narrative review. Human Reproduction Update 19(6): 625–639.

12.

Cunnington

Hirose

(2024) Disregarded, devalued and lacking diversity: An exploration into women’s experiences with endometriosis. A systematic review and narrative synthesis of qualitative data. Journal of Endometriosis and Uterine Disorders 8: 1–14.

13.

Evans

Keenan

Shipton

(2007) Psychosocial adjustment and physical health of children living with maternal chronic pain. Journal of Paediatrics and Child Health 43(4): 262–270.

14.

Evans

Mikocka-Walus

Olive

, et al. (2021) Phenotypes of women with and without endometriosis and relationship with functional pain disability. Pain Medicine 22(7): 1511–1521.

15.

Evans

Moloney

Seidman

, et al. (2018) Parental bonding in adolescents with and without chronic pain. Journal of Pediatric Psychology 43(3): 276–284.

16.

Facchin

Barbara

Dridi

, et al. (2017) Mental health in women with endometriosis: Searching for predictors of psychological distress. Human Reproduction 32(9): 1855–1861.

17.

Fletcher

GJO

Simpson

Thomas

(2000) The measurement of perceived relationship quality components: A confirmatory factor analytic approach. Personality and Social Psychology Bulletin 26: 340–354.

18.

Fourquet

Gao

Zavala

, et al. (2010) Patients’ report on how endometriosis affects health, work, and daily life. Fertility and Sterility 93(7): 2424–2428.

19.

Gudka

Kelman

Bryant

, et al. (2023) Parent-carer experiences using a peer support network: A qualitative study. BMC Public Health 23(1): 2007.

20.

Hållstam

Stålnacke

Svensén

, et al. (2018) Living with painful endometriosis – A struggle for coherence: A qualitative study. Sexual & Reproductive Healthcare 17: 97–102.

21.

Hawker

Mian

Kendzerska

, et al. (2011) Measures of adult pain: Visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), Short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care & Research 63: S240–S252.

22.

Henry

Crawford

(2005) The short-form version of the depression anxiety stress scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology 44: 227–239.

23.

IBM Corp (2023) IBM SPSS Statistics Version 30.0. IBM Corp.

24.

Jackson

Bazeley

(2019) Qualitative data analysis with NVivo, 3rd ed. London: Sage Publications.

25.

Karnieli-Miller

Strier

Pessach

(2009) Power relations in qualitative research. Qualitative Health Research 19(2): 279–289.

26.

Katz

Evans

Mikocka-Walus

(2025) ‘Listen to women as if they were your most cherished person’: Australian women’s perspectives on living with the pain of endometriosis: A mixed-methods study. Journal of Health Psychology 30: 1899–1914. https://doi.org/10.1177/13591053241250101

27.

Kim

Sefcik

Bradway

(2017) Characteristics of qualitative descriptive studies: A systematic review. Research in Nursing & Health 40(1): 23–42.

28.

Kocas

Rubin

Lobel

(2023) Stigma and mental health in endometriosis. European Journal of Obstetrics & Gynecology and Reproductive Biology X 19: 100228.

29.

Lovibond

(1995) Manual for the Depression Anxiety Stress Scales. Psychology Foundation.

30.

Maggiore

ULG

Chiappa

Ceccaroni

, et al. (2024) Epidemiology of infertility in women with endometriosis. Best Practice & Research Clinical Obstetrics & Gynaecology 92: 102454.

31.

Meek

Bergeron

Towne

, et al. (2018) Restricted social engagement among adults living with chronic conditions. International Journal of Environmental Research and Public Health 15(1): 158.

32.

Missmer

Agarwal

, et al. (2021) Impact of endometriosis on life-course potential: A narrative review. International Journal of General Medicine 14: 9–25.

33.

Monin

Levy

Doyle

, et al. (2019) The impact of both spousal caregivers’ and care recipients’ health on relationship satisfaction in the caregiver health effects study. Journal of Health Psychology 24(12): 1744–1755.

34.

Moradi

Parker

Sneddon

, et al. (2014) Impact of endometriosis on women’s lives: A qualitative study. BMC Women’s Health 14: 123.

35.

Navarria-Forney

Bénard

Mazloum

, et al. (2020) A web-based survey of reproductive awareness and choices in women with endometriosis. European Journal of Obstetrics, Gynecology, and Reproductive Biology 251: 106–113.

36.

Niehuis

Davis

Reifman

, et al. (2024) Psychometric evaluation of single-item relationship satisfaction, love, conflict, and commitment measures. Personality and Social Psychology Bulletin 50: 387–405.

37.

Norinho

Martins

Ferreira

(2020) A systematic review on the effects of endometriosis on sexuality and couple’s relationship. Facts, Views & Vision in ObGyn 12(3): 197–205.

38.

Parton

Katz

Ussher

(2019) ‘Normal’ and ‘failing’ mothers: Women’s constructions of maternal subjectivity while living with multiple sclerosis. Health: An Interdisciplinary Journal for the Social Study of Health Illness and Medicine 23(5): 516–532.

39.

Power

Jackson

Weaver

, et al. (2011) Social support for mothers in illness: A multifaceted phenomenon. Contemporary Nurse 40(1): 27–40.

40.

Qualtrics (2021) XM ed. Qualtrics XM (Experience Management platform) [Computer software]. Qualtrics.

41.

Rees

O’Boyle

MacDonagh

(2001) Quality of life: Impact of chronic illness on the partner. Journal of the Royal Society of Medicine 94(11): 563–566.

42.

Rempert

Liu

, et al. (2024) A systematic review of the psychosocial impact of endometriosis before and after treatment. Reproductive Sciences 31(7): 1828–1860.

43.

Rush

Misajon

(2018) Examining subjective wellbeing and health-related quality of life in women with endometriosis. Health Care for Women International 39(3): 303–321.

44.

Sandelowski

(2000) Whatever happened to qualitative description? Research in Nursing & Health 23(4): 334–340.

45.

Shahhosseini

Gardeshi

Pourasghar

, et al. (2014) A review of affecting factors on sexual satisfaction in women. Materia Socio-Medica 26(6): 378–381.

46.

Sims-Schouten

Riley

Willig

(2007) Critical realism in discourse analysis: A presentation of a systematic method of analysis using women’s talk of motherhood, childcare and female employment as an example. Theory & Psychology 17(1): 101–124.

47.

Sirohi

Freedman

, et al. (2023) Patient experiences of being advised by a healthcare professional to get pregnant to manage or treat endometriosis: A cross-sectional study. BMC Women’s Health 23(1): 638.

48.

Suvitie

Hallamaa

Matomäki

, et al. (2016) Prevalence of pain symptoms suggestive of endometriosis among Finnish adolescent girls (TEENMAPS study). Journal of Pediatric and Adolescent Gynecology 29: 97–103.

49.

van Stein

Schubert

Ditzen

, et al. (2023) Understanding psychological symptoms of endometriosis from a research domain criteria perspective. Journal of Clinical Medicine 12(12): 4056.

50.

Vitale

La Rosa

Rapisarda

AMC

, et al. (2017) Endometriosis and infertility: The impact on quality of life and mental health. Journal of Endometriosis and Pelvic Pain Disorders 9(2): 112–115.

51.

Weitkamp

Feger

Landolt

, et al. (2021) Dyadic coping in couples facing chronic physical illness: A systematic review. Frontiers in Psychology 12: 722740.

52.

Wooditch

Johnson

Solymosi

, et al. (2021) Comparing two-sample means or proportions. In: Wooditch

Johnson

Solymosi

, et al. (eds) A Beginner’s Guide to Statistics for Criminology and Criminal Justice Using R. Springer International Publishing, pp.169–182.

53.

World Health Organization (2023) Endometriosis. Available at: https://www.who.int/news-room/fact-sheets/detail/endometriosis.

54.

Zimet

Dahlem

Zimet

, et al. (1988a) The multidimensional scale of perceived social support. Journal of Personality Assessment 52(1): 30–41.

55.

Zimet

Powell

Farley

, et al. (1990) Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment 55: 610–617.