Lifestyle Factors and Symptom Burden in Endometriosis: An Exploratory Mixed-Methods Analysis of Nutrition, Physical Activity, and Psychosocial Well-being

Lifestyle Factors and Symptom Burden in Endometriosis: An Exploratory Mixed-Methods Analysis of Nutrition, Physical Activity, and Psychosocial Well-being | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lifestyle Factors and Symptom Burden in Endometriosis: An Exploratory Mixed-Methods Analysis of Nutrition, Physical Activity, and Psychosocial Well-being Laura Wulfhorst, Andrea Henze, Dorothea Portius This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-10040648/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Endometriosis affects approximately 10% of reproductive-age women worldwide, with symptom burden significantly impacting quality of life. While current treatment guidelines focus primarily on hormonal and surgical interventions, the role of lifestyle factors in symptom management remains underexplored. Major clinical guidelines acknowledge insufficient evidence for specific lifestyle recommendations, highlighting the need for exploratory research. Therefore, our aim is to explore potential associations between lifestyle factors (nutrition, physical activity, psychosocial well-being) and symptom burden in women with endometriosis using a mixed-methods approach. Methods A convergent mixed-method design combining cross-sectional online surveys (n = 378) with semi-structured expert interviews (n = 5) was conducted between January and March 2025. Lifestyle factors were assessed using newly developed indices for dietary habits, physical activity, and psychosocial well-being. Symptom burden was evaluated using validated endometriosis-specific instruments and numeric rating scales. Results In exploratory analyses, the Dietary Habits Index was not significantly associated with overall symptom burden in the study cohort. However, subgroup analysis revealed a weak negative correlation in participants without food intolerances (β = -0.144, p = 0.021). Physical activity and psychosocial well-being indices showed weak associations with symptom burden (physical activity: β = 0.133, p = 0.010; psychosocial well-being: β = -0.261, p < 0.001). Expert interviews emphasized the importance of individualized, multimodal approaches and highlighted psychosocial factors as particularly relevant for symptom management. Conclusions This exploratory study suggests modest associations between certain lifestyle factors and endometriosis symptom burden. The findings support the need for individualized lifestyle interventions as adjuncts to conventional medical treatment. Given the limited evidence base and methodological constraints, these hypothesis-generating results require validation through well-designed longitudinal studies and randomized controlled trials. Endometriosis Lifestyle factors Dietary habits Physical activity Psychosocial well-being Symptom burden Mixed-methods study Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterialWulfhorstetal20260602.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 14 Jul, 2026 Reviewers agreed at journal 13 Jul, 2026 Reviews received at journal 29 Jun, 2026 Reviewers agreed at journal 24 Jun, 2026 Reviewers invited by journal 23 Jun, 2026 Editor invited by journal 20 Jun, 2026 Editor assigned by journal 15 Jun, 2026 Submission checks completed at journal 15 Jun, 2026 First submitted to journal 15 Jun, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-10040648","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":668866887,"identity":"d5c46684-e4db-490c-a62f-9093ee691c06","order_by":0,"name":"Laura Wulfhorst","email":"","orcid":"","institution":"Martin Luther University Halle-Wittenberg","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Wulfhorst","suffix":""},{"id":668866888,"identity":"141c59b8-0785-4865-9737-cbd312e85af7","order_by":1,"name":"Andrea Henze","email":"","orcid":"","institution":"Martin Luther University Halle-Wittenberg","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Henze","suffix":""},{"id":668866889,"identity":"303b1dd1-3475-48f7-a06c-17f6d2125d2b","order_by":2,"name":"Dorothea Portius","email":"data:image/png;base64,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","orcid":"","institution":"Martin Luther University Halle-Wittenberg","correspondingAuthor":true,"prefix":"","firstName":"Dorothea","middleName":"","lastName":"Portius","suffix":""}],"badges":[],"createdAt":"2026-06-15 09:10:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-10040648/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-10040648/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":113512710,"identity":"9b998568-0da0-4a13-84d5-479e840e94fc","added_by":"auto","created_at":"2026-06-30 23:39:40","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":813435,"visible":true,"origin":"","legend":"","description":"","filename":"WulfhorstetalIJBNPA20260602.pdf","url":"https://assets-eu.researchsquare.com/files/rs-10040648/v1_covered_98bf5035-96b3-40fb-b79c-e8972011b928.pdf"},{"id":113504135,"identity":"5d098c73-ccfc-443a-8a2f-f22bc99105e9","added_by":"auto","created_at":"2026-06-30 22:20:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":331839,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialWulfhorstetal20260602.docx","url":"https://assets-eu.researchsquare.com/files/rs-10040648/v1/6901730a35345d6feac7dde5.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Lifestyle Factors and Symptom Burden in Endometriosis: An Exploratory Mixed-Methods Analysis of Nutrition, Physical Activity, and Psychosocial Well-being","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Endometriosis, Lifestyle factors, Dietary habits, Physical activity, Psychosocial well-being, Symptom burden, Mixed-methods study","lastPublishedDoi":"10.21203/rs.3.rs-10040648/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-10040648/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEndometriosis affects approximately 10% of reproductive-age women worldwide, with symptom burden significantly impacting quality of life. While current treatment guidelines focus primarily on hormonal and surgical interventions, the role of lifestyle factors in symptom management remains underexplored. Major clinical guidelines acknowledge insufficient evidence for specific lifestyle recommendations, highlighting the need for exploratory research. Therefore, our aim is to explore potential associations between lifestyle factors (nutrition, physical activity, psychosocial well-being) and symptom burden in women with endometriosis using a mixed-methods approach.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA convergent mixed-method design combining cross-sectional online surveys (n\u0026thinsp;=\u0026thinsp;378) with semi-structured expert interviews (n\u0026thinsp;=\u0026thinsp;5) was conducted between January and March 2025. Lifestyle factors were assessed using newly developed indices for dietary habits, physical activity, and psychosocial well-being. Symptom burden was evaluated using validated endometriosis-specific instruments and numeric rating scales.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn exploratory analyses, the Dietary Habits Index was not significantly associated with overall symptom burden in the study cohort. However, subgroup analysis revealed a weak negative correlation in participants without food intolerances (β = -0.144, p\u0026thinsp;=\u0026thinsp;0.021). Physical activity and psychosocial well-being indices showed weak associations with symptom burden (physical activity: β\u0026thinsp;=\u0026thinsp;0.133, p\u0026thinsp;=\u0026thinsp;0.010; psychosocial well-being: β = -0.261, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Expert interviews emphasized the importance of individualized, multimodal approaches and highlighted psychosocial factors as particularly relevant for symptom management.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis exploratory study suggests modest associations between certain lifestyle factors and endometriosis symptom burden. The findings support the need for individualized lifestyle interventions as adjuncts to conventional medical treatment. Given the limited evidence base and methodological constraints, these hypothesis-generating results require validation through well-designed longitudinal studies and randomized controlled trials.\u003c/p\u003e","manuscriptTitle":"Lifestyle Factors and Symptom Burden in Endometriosis: An Exploratory Mixed-Methods Analysis of Nutrition, Physical Activity, and Psychosocial Well-being","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-06-30 18:51:06","doi":"10.21203/rs.3.rs-10040648/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"143645482584665383566102954292303253608","date":"2026-07-14T09:06:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120924319485229740909442238290887597296","date":"2026-07-13T18:28:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-06-29T19:34:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135945780212316139354700744842997528862","date":"2026-06-24T06:00:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-06-23T17:54:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-06-20T06:47:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-06-15T23:31:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-06-15T23:31:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-06-15T09:03:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d43903d-18b6-4304-bf40-d32c3b37ba79","owner":[],"postedDate":"June 30th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"143645482584665383566102954292303253608","date":"2026-07-14T09:06:08+00:00","index":79,"fulltext":""},{"type":"reviewerAgreed","content":"120924319485229740909442238290887597296","date":"2026-07-13T18:28:17+00:00","index":78,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-06-29T19:34:32+00:00","index":42,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-06-30T18:51:12+00:00","versionOfRecord":[],"versionCreatedAt":"2026-06-30 18:51:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-10040648","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-10040648","identity":"rs-10040648","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}