The closer, the better? The impact of generational residential distance on older adults' mental health: evidence from China.

Endometriosis is a chronic, estrogen-dependent, systemic, and inflammatory gynecological disease characterized by the presence of endometrial-like tissue outside the uterine cavity (–). It causes a wide range of symptoms, including chronic pelvic pain, dysmenorrhea, dyspareunia, dyschezia, and infertility (, ), which may be widespread and persist despite treatment (, , ). The condition affects approximately 10%–15% of women of reproductive age worldwide (). Despite its prevalence, endometriosis is often described as a “missed disease” due to its unclear etiology and frequent diagnostic delays (), partly because up to 20%–25% of women with endometriosis present with nonspecific symptoms or remain asymptomatic (). Moreover, no single treatment currently provides a complete cure (). Given its complex nature, endometriosis significantly affects physical, psychological, and social functioning, ultimately reducing quality of life (QoL). The World Health Organization (WHO) defines QoL as an individual's perception of their position in life within the context of their culture, value systems, goals, expectations, and concerns (). QoL encompasses multiple dimensions, including physical health, psychological state, functional independence, social relationships, belief systems, and environmental context (). However, the impact of endometriosis extends beyond these categories (–). Research shows that the condition alters women's QoL across numerous dimensions, including physical, psychological, social, sexual and intimate functioning, fertility, work life, finances, education, and lifestyle (, , ). Recent evidence further emphasizes the importance of comprehensive, disease-specific QoL assessment tools capable of capturing these multidimensional effects and supporting patient-centered care (). Women with endometriosis frequently report a markedly reduced QoL compared with the general population (). QoL outcomes may also vary according to socio-demographic, clinical, and psychological factors, highlighting the importance of examining multiple determinants of disease burden (). Symptoms can limit daily functioning, sexual activity, intimate relationships, and work performance, contributing to frustration, anxiety, and depression (). Chronic pain is a predominant symptom, occurring particularly during menstruation, during or after sexual intercourse, and during urination or defecation (). Pain during defecation, with or without constipation, may result from bowel involvement, inflammation, or adhesions, and can substantially interfere with daily activities (–). Dyspareunia negatively affects sexual function and intimate relationships, increasing relationship-related stress and psychological burden (). Fertility difficulties may also lead to emotional distress and reduced psychological well-being (). Overall, chronic pain, infertility, and psychological factors such as anxiety and depression are consistently identified as key predictors of reduced QoL in women with endometriosis ().