Understanding Physical Activity for Women with Endometriosis Symptoms (PAWES): interplay of barriers, benefits and experiences in women from diverse..

..backgrounds. An interdisciplinary approach.
Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes, causing (often severe) discomfort, pain and disability. For all women of reproductive age 10% will have endometriosis, representing around 1.5million in the UK. However, there are likely many more that are undiagnosed, it currently takes an average of 7.5years from onset of symptoms for a conclusive diagnosis, through a laparoscopy. In 2020 the All-Party Parliamentary Group (APPG) on Endometriosis, in collaboration with Endometriosis UK, conducted a survey which included the experiences of 10000 women with endometriosis in the UK. Recommendations from the report included increasing research funding to understand, treat and manage endometriosis, and addressing socioeconomic and ethnic differences. The human cost of endometriosis is substantial, given its overall prevalence, and its impact on day-to-day function during work and leisure, relational and mental health and quality of life(QoL). Furthermore, understanding and implementing management strategies for endometriosis will ultimately have a positive impact on productivity, endometriosis has been shown to have a negative effect on productivity in the workplace due to debilitating symptoms, costing the UK economy £8billion per year. Moreover, prevalence appears to differ according to ethnic background with white women more likely to be diagnosed than black women, and Asian women more likely than white women. Whether it is a true representation of prevalence in different ethnicities or due to implicit biases in the healthcare system, remains unknown. The sociodemographic differences in the condition's impact on society, also underscore its importance as a driver of health inequalities. Treatment for endometriosis most often involves a laparoscopic excision of the endometrium,however 50% of women will develop endometriosis again within 5years of surgery, while other medical treatments lead to significant side-effects. As a result, women with endometriosis often turn to complementary treatments and lifestyle changes to manage their symptoms, however there is currently no guidance or support from health professionals to assist them due to the absence of a scientific evidence base. Being physically active has been shown to be an important therapeutic tool for improving mental health and QoL, and reducing pain in many adults with other chronic conditions, therefore it has significant potential for managing endometriosis symptoms and improving the experience of women with this condition. However, this has never been examined. In order to understand the therapeutic potential of different types of physical activity(PA) for endometriosis and to inform healthcare practice and policy, a comprehensive understanding of the prevalence of endometriosis diagnosis, its symptoms and impact on daily function, and the sociodemographic and cultural drivers of PA amongst women living with endometriosis, is required.
Detailed understanding of endometriosis prevalence, symptoms, day-to-day PA patterns and how they differ according to sociodemographic factors, requires precise analysis of highquality secondary data using advance quantitative methods. However, in order to truly understand;1) the diverse experiences of women with endometriosis,2) how they live with and manage the condition,3) the complex sociocultural and environmental drivers of PA behaviours, and4) the perceived benefits and/or harm of different physical activities, a deep and detailed qualitative exploration, working with women affected by this condition, is necessary. The proposed interdisciplinary PhD project will draw on advanced quantitative methods from social epidemiology and statistics, and qualitative social science methods to provide the first detailed understanding of the potential for PA as a therapeutic tool for endometriosis.