Executive Functions Mediate Between Endometriosis Burden and Women's Daily Life
Sewar Khatib1, Haya Hassan2, Suzan Abd Elgani2
1Department of Occupational Therapy, University of Haifa, Haifa, Israel.
International Journal of Women'S Health
|June 9, 2026
Summary
Women with endometriosis experience worse executive functioning, occupational balance, and quality of life. Executive functioning fully mediates the impact of disease burden on daily life, suggesting it as a key intervention target.
Area of Science:
- Reproductive Medicine
- Clinical Psychology
- Rehabilitation Science
Background:
- Endometriosis significantly impacts women's health, affecting physical, psychological, and social well-being.
- Disease burden in endometriosis includes pain, psychological distress, and reduced quality of life.
- Executive functioning plays a crucial role in daily life management and adaptation to chronic conditions.
Purpose of the Study:
- Compare executive functioning, disease burden, occupational balance, and quality of life between women with endometriosis and healthy controls.
- Investigate associations between pain-related/psychological disease burden (pain catastrophizing, emotional distress) and occupational balance/quality of life.
- Examine if executive functioning mediates the relationship between disease burden and functional outcomes (quality of life, occupational balance).
Main Methods:
- Cross-sectional correlational study with 103 women (43 endometriosis, 60 controls, aged 18-35).
- Assessed disease burden (pain severity, pain catastrophizing, emotional distress), executive functioning, occupational balance, and quality of life using validated scales.
- Employed mediation analyses (Hayes' PROCESS) to test the mediating role of executive functioning.
Main Results:
- Women with endometriosis showed significantly higher pain, pain catastrophizing, emotional distress, and executive functioning difficulties, with lower occupational balance and quality of life compared to controls (p <0.001).
- Within the endometriosis group, greater pain catastrophizing and emotional distress correlated with poorer executive functioning, which in turn was linked to reduced occupational balance and quality of life (p <0.001).
- Executive functioning fully mediated the associations between psychological disease burden and both quality of life and occupational balance.
Conclusions:
- Executive functioning is a central mechanism linking endometriosis-related disease burden to daily life disruptions.
- Findings support an integrative, function-oriented model of endometriosis, moving beyond symptom-based understanding.
- Executive functioning emerges as a critical target for comprehensive, person-centered assessment and intervention in endometriosis care.
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