Abstract
Efficient cognitive functioning is essential for human success and quality of life, and our ability to think clearly and flexibly undoubtedly determines whether we flourish or falter. Those with endometriosis – a gynaecological health condition characterized by abnormal endometrial cell growth – frequently self-report cognitive difficulties, compromising nearly all facets of daily functioning and overall wellbeing. Despite the high prevalence of cognitive complaints, they are not part of the clinical workup due to very little being known about the objective cognitive functioning of individuals with endometriosis, leaving them unaddressed clinically. Without first defining a cognitive profile and elucidating associated brain activity in this population, our ability to address the cognitive impact of this condition remains critically compromised. The current thesis therefore set out with two primary objectives: 1) to characterize for the first time cognitive functioning in biological women with endometriosis, and 2) to identify brain-based biomarkers for potential cognitive rehabilitative therapies. Following a systematic review that informed subsequent experimental chapters, this thesis presents the first comprehensive evidence of objectively measured cognitive deficits in biological women with endometriosis. These objective deficits were most pronounced in cases of endometriosis with chronic pelvic pain, whereby pain factors (e.g., severity, frequency, and intrusion) and affective symptomatology (namely depression and anxiety) emerged as significant drivers of cognitive disruptions – determined via moderation analyses. This thesis also identified three candidate brain-based biomarkers of cognitive dysfunction in endometriosis via electroencephalography and near-infrared spectroscopy, together representing aberrated neural functioning, reflected in visual and auditory P300 event-related potentials and cerebral oxygenation patterns. By synthesizing behavioural and neuroimaging data, this thesis provides novel insights into the complex consequences of endometriosis on brain functioning and advances the field to a stage where interventions aimed at alleviating cognitive symptoms can begin.