Sleep Quality Among Women with Endometriosis in Bangladesh: A Hospital- Based Cross-Sectional Study

For millions of women worldwide, the monthly cycle brings more than just a change in the calendar; it brings a chronic, invisible burden known as endometriosis. This condition occurs when tissue similar to the lining of the uterus grows outside the womb, causing inflammation, severe pain, and a host of other physical symptoms that can disrupt daily life. While doctors have long understood how this disease affects fertility and causes pelvic pain, a quieter, often overlooked consequence has only recently begun to receive attention: the profound impact on sleep. Sleep is not merely a passive state of rest but a vital biological process that allows the body to repair itself and the mind to reset. When pain interrupts this cycle, it creates a vicious loop where poor rest makes pain feel worse, and worsening pain makes rest impossible. Understanding this connection is crucial, not just for medical science, but for the daily well-being of the women living with this condition.

Until now, most of what we know about sleep and endometriosis comes from studies in Europe, North America, and parts of Asia. There has been a significant gap in knowledge regarding how this relationship plays out in South Asia, specifically in Bangladesh, where cultural factors and healthcare access might shape the experience of the disease differently. To fill this void, a team of researchers from BRAC University set out to investigate the sleep patterns of women with endometriosis in Dhaka. They conducted a careful comparison between two groups of women: those with a confirmed diagnosis of endometriosis and a group of healthy women with no history of gynecological disorders. By bringing these two groups together in a hospital setting, the researchers aimed to see if the disease itself was linked to a specific kind of exhaustion that went beyond simple tiredness.

The study took place over a year and a half at Kurmitola General Hospital, where the team enrolled 401 women between the ages of 17 and 45. Half of the participants had been clinically diagnosed with endometriosis, while the other half served as a healthy control group. To measure sleep, the researchers used a widely trusted tool called the Pittsburgh Sleep Quality Index, which asks detailed questions about how a person sleeps over the previous month. This questionnaire looks at several specific aspects of rest, such as how long it takes to fall asleep, how many hours are actually spent sleeping, how often a person wakes up during the night, and how much daytime fatigue they feel. A score above a certain threshold indicates that a person is a "poor sleeper," meaning their rest is fragmented or insufficient.

The results painted a clear and concerning picture. Among the women with endometriosis, nearly 69 percent were classified as poor sleepers. In contrast, the healthy control group showed much better sleep patterns. When the researchers broke down the specific components of sleep, the women with endometriosis struggled significantly more than the healthy women in almost every category. They took longer to fall asleep, slept for shorter periods, woke up more frequently, and felt more tired and unable to function during the day. The only area where the two groups did not differ significantly was the use of sleep medication, suggesting that despite their struggles, the women with endometriosis were not turning to pills to help them rest any more than the healthy women were.

Perhaps the most revealing part of the study was the link between specific symptoms and sleep quality. The researchers found that the women who reported the most severe pain were the ones sleeping the worst. Symptoms such as painful intercourse, severe menstrual cramps, heavy bleeding, and pain in the lower back or abdomen were all strongly associated with poor sleep. Interestingly, the study showed that factors like a woman's age, her body mass index, or her level of education had no significant connection to how well she slept. This suggests that the sleep disturbance is driven directly by the physical symptoms of the disease rather than by social or demographic circumstances.

One finding stood out as slightly unexpected: when asked to rate their own subjective sleep quality, the women with endometriosis actually gave themselves slightly better scores than the healthy women, even though their objective measures showed they were sleeping much worse. This discrepancy might indicate that women living with chronic pain have adjusted their expectations of what a "good night's sleep" looks like, or that they are so accustomed to the struggle that they do not perceive their sleep as being as poor as the data suggests. It highlights a complex gap between how people feel about their rest and what is actually happening in their bodies.

The researchers were careful to note that because this was a snapshot in time, they could not prove that the disease causes the bad sleep, or that bad sleep causes the disease. However, the strength of the association suggests a deep connection that needs to be addressed in medical care. The study also acknowledged its limitations, such as the fact that it was conducted in a single hospital, which means the results might not represent every woman with endometriosis in Bangladesh. Additionally, the sleep data relied on the women's own reports rather than objective machines that track brain waves or movement. Despite these constraints, the study provides the first solid evidence from Bangladesh that endometriosis is not just a reproductive issue but a condition that deeply disrupts the fundamental human need for rest.

The implications of these findings are straightforward. For doctors treating women with endometriosis in Bangladesh, checking how a patient sleeps should become a standard part of the conversation, just as checking for pain or bleeding is today. Recognizing that poor sleep is a common and expected part of the disease could lead to better management strategies that address the whole person, not just the reproductive symptoms. By validating the struggle these women face, the study opens the door for future research that might test whether improving sleep can help reduce the overall burden of the disease. For now, the message is clear: for many women with endometriosis, the night is as much a battlefield as the day, and finding a way to rest is an essential part of healing.