Abstract
Background: Advanced endometriosis substantially impairs health-related quality of life (HRQoL). This prospective cohort study assessed six-month changes in HRQoL and pain following surgical treatment and postoperative hormonal therapy and explored whether postoperative changes and adverse-effect profiles differed according to hormonal treatment. Methods: Fifty women with histologically confirmed rASRM stage III–IV endometriosis underwent surgical treatment. SF-36v2 and Numerical Rating Scale (NRS) scores were assessed preoperatively and at six months. Paired changes, correlations with pain reduction, disease-stage differences, and exploratory comparisons among dienogest, GnRH-agonist, and combined ethinylestradiol/dienogest (EE/DNG) treatment groups were analysed. Adverse effects were compared using the Fisher–Freeman–Halton exact test with Holm adjustment. Results: All eight SF-36v2 domains improved significantly (all p < 0.001; r = 0.74–0.87), and median NRS pain decreased from 8 (IQR 7–8) to 2 (IQR 1–3) (p < 0.001; r = 0.87). Pain reduction was positively associated with improvement across all SF-36v2 domains; seven of eight correlations were statistically significant before adjustment, while four remained significant after Holm correction, with the strongest association observed for Bodily Pain (ρ = 0.538). No statistically significant differences in pain or HRQoL change were detected by rASRM stage or postoperative hormonal regimen. Hot flushes differed across hormonal groups and were most frequent with GnRH-agonist therapy (56.3%; Holm-adjusted p = 0.010). Conclusions: Six months after surgery and postoperative hormonal therapy for advanced endometriosis, substantial improvements in HRQoL and pain were observed. HRQoL improvement was only partly associated with pain reduction. Exploratory comparisons among postoperative hormonal regimens did not detect differences in patient-reported improvement, whereas tolerability profiles differed, particularly with respect to hot flushes in the GnRH-agonist group. Because treatment allocation was not randomized, these findings do not establish comparative efficacy or treatment equivalence.