# Impact of adverse childhood experiences on health-related quality of life in Australian women with endometriosis: a population-based cohort study

## TL;DR

Women with endometriosis who experienced childhood trauma have significantly worse quality of life, especially in social and emotional domains.

## Contribution

This study is the first to show a dose-response relationship between childhood adversity and health outcomes in endometriosis patients using a large population-based cohort.

## Key findings

- Higher ACE scores correlate with worse HRQoL in endometriosis patients across multiple domains.
- Psychological abuse, physical abuse, and household mental illness are most strongly linked to poor HRQoL.
- Trauma-informed care is recommended for endometriosis management based on these associations.

## Abstract

To examine the associations between adverse childhood experiences (ACEs) and health-related quality of life (HRQoL) among Australian women with endometriosis.

This population-based cohort study included 1,120 women with endometriosis born in 1973–78 and 1989–95, using data from the Australian Longitudinal Study on Women’s Health and its sub-study, the Genetic variants, Early Life exposures, and Longitudinal Endometriosis symptoms Study. HRQoL was assessed using the Endometriosis Health Profile-30, and ACEs were measured using a validated 21-item questionnaire. Ordinal logistic regression models were used for analyses.

Women who experienced ACEs were more likely to be diagnosed with endometriosis than those who did not. Among women with endometriosis, a clear dose-response relationship was observed, with higher cumulative ACE scores and greater trauma severity associated with progressively poorer HRQoL across all domains. In the 1973–78 cohort, the strongest associations between cumulative ACEs and HRQoL were observed in the domains of social support, self-image, and emotional well-being, with adjusted odds ratios (95% CIs) of 1.41 (1.24, 1.58), 1.41 (1.24, 1.60), and 1.30 (1.15, 1.46), respectively. Women reporting very/extremely traumatic experiences also had significantly worse outcomes across all domains, particularly for social support 4.42 (2.36, 8.28), emotional well-being 4.38 (2.36, 8.12), and self-image 3.29 (1.77, 6.11). Psychological abuse, physical abuse, and household mental illness were consistently associated with poorer HRQoL, particularly in the social support domain. Similar patterns were observed in the 1989–95 cohort, though with some domain-specific variations.

Childhood adversity significantly impairs HRQoL in women with endometriosis, particularly psychological abuse, physical abuse, and household mental illness. These findings highlight the need for trauma-informed care in endometriosis management, with careful consideration of the limitations of routine ACE screening.

The online version contains supplementary material available at 10.1007/s11136-025-04160-1.