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Endometriosis and Mental health

Updated: Nov 30, 2022

Endometriosis is a benign, chronic, inflammatory disease that affects about one in 10 women of reproductive age. It is characterized by the development of endometrium (tissue lining the uterus) in a variable location outside the uterus. In about 90% of cases, this tissue lodges in the pelvis, implanting itself in organs located there. During a woman's menstrual cycle, this tissue undergoes several transformations similar to those that occur in the uterus, causing significant suffering for the woman.

Despite increasing research on this topic, and some theories being developed, the etiology and origin of endometriosis still remains unknown.

Often, the first difficulty associated with this disease is the excessive time that elapses from the appearance of the first symptoms to its effective diagnosis. These delays in diagnosis (and sometimes misdiagnosis), besides resulting in more costs to the National Health Service, lead to greater psychological suffering for these patients. Thus, it is essential that the diagnosis be early and appropriate, so that an idiosyncratic treatment can subsequently be designed, thus avoiding the progression and worsening of the disease.

According to the literature, this disease is associated with several symptoms, the most frequent being: pain associated with menstruation (dysmenorrhea), pain associated with sexual intercourse (dyspareunia) and pelvic pain. Sometimes endometriosis can cause widespread and chronic pain. In addition, this disease has also been associated with sexual dysfunction in women, and although research does not allow a cause-and-effect relationship to be established between endometriosis and infertility, these conditions are often associated as well. Since in endometriosis the most affected organs are precisely the female reproductive organs (i.e. vagina, ovaries, fallopian tubes), the reproductive function may be altered and infertility may be associated. Despite this, it should be noted that treatment of endometriosis often improves a woman's fertility potential and, in some situations, results in a successful pregnancy.

The presence of constant pain and discomfort in the lives of these women has a major negative impact at the psychological and emotional levels. For example, lack of control and helplessness in the face of the disease and its evolution, and even little knowledge about it, may increase the vulnerability of women with endometriosis to the development of psychopathological symptoms and general psychological distress. Research has shown a positive association between endometriosis and the experience of stress, anxious symptomatology, depressive symptomatology, feelings of hopelessness, low self-esteem, social dysfunction, and lower levels of quality of life and psychological well-being.

Endometriosis has no cure, but it does have treatment - this should be tailored to the characteristics of the person and the disease, always taking into account variables such as age, presenting complaints, reproductive desire, beliefs about the disease and its impact, and the degree of disease progression.

In general, the treatment approach should be integrative and multidisciplinary, including pharmacological and/or surgical therapy (in some cases). Some studies show that psychological intervention in the treatment of endometriosis may represent an important therapeutic tool, especially for women who have undergone several surgical/pharmacological treatments and experienced recurrence of symptoms.

The scientific literature has shown some promising results in this context. In general, cognitive-behavioral therapy is considered an evidence-based therapy effective in the treatment of pain-related conditions (including chronic pain). Specifically, the promotion of *mindfulness* skills in chronic pain conditions has been shown to be highly relevant for women with endometriosis and is associated with improved quality of life. The promotion of self-care strategies is also associated with improved quality of life and mental health promotion in these patients. In addition, interventions including yoga practices, relaxation training, cognitive-behavioral therapy combined with physical therapy, and biofeedback, have resulted in relief of pain, depressive and anxious symptoms, stress, and fatigue in women with endometriosis. While the scientific research shows encouraging results, future studies using more robust methodologies in evaluating the effectiveness of these interventions, specifically considering this health condition, are needed.

If you have received a diagnosis of endometriosis and are experiencing psychological distress or emotional difficulties, seek specialized professional help. Also get to know WomanEndo, the Portuguese Association of Support for Women with Endometriosis - being aware that you are not alone, nor do you need to go through this alone, may help you in this process.


Chaman-Ara, K., Bahrami, M., & Bahrami, E. (2017). Endometriosis psychological aspects: A literature review. Journal of Endometriosis and Pelvic Pain Disorders, 9(2), 105-111.

Culley, L., Law, C., Hudson, N., Denny, E., Mitchell, H., Baumgarten, M., & Raine-Fenning, N. (2013). The social and psychological impact of endometriosis on women's lives: A critical narrative review. Human Reproduction Update, 19(6), 625–639.

Evans, S., Fernandez, S., Olive, L., Payne, L. A., & Mikocka-Walus, A. (2019). Psychological and mind-body interventions for endometriosis: A systematic review. Journal of Psychosomatic Research, 124.

Facchin, F., Barbara, G., Dridi, D., Alberico, D., Buggio, L., Somigliana, E., Saita, E., & Vercellini, P., (2017). Mental health in women with endometriosis: Searching for predictors of psychological distress. Human Reproduction, 32(9), 1855-1861.

Hansen, K., Kesmodel, U., Kold, M., & Forman, A. (2017). Long-term effects of mindfulness-based psychological intervention for coping with pain in endometriosis: A six-year follow-up on a pilot study. Nordic Psychology, 69(2), 100-109.

Kold, M., Hansen, T., Vedsted-Hansen, H., & Forman, A. (2012) Mindfulness-based psychological intervention for coping with pain in endometriosis. Nordic Psychology, 64(1), 2-16,

Nascimento, C. (2017). Psicopatologia e qualidade de vida na endometriose (Doctoral dissertation, Universidade da Beira Interior, Portugal).

Rossi, V., Tripodi, F., Simonelli, C., Galizia, R., & Nimbi, F. (2021). Endometriosis-associated pain: A review of quality of life, sexual health and couple relationship. Minerva Obstetrics and Gynecology, 73(5), 536-552.

Zarbo, C., Brugnera, A., Compare, A., Malandrino, C., Candeloro, I., Secomandi, R., Betto, E., Bellia, A., Rabboni, M., Bondi, E., & Frigerio, L. (2022). Psychological and cognitive factors implicated in pain experience in women with endometriosis. Health Care Women International, 43, 142-159. - MulherEndo – Associação Portuguesa de Apoio a Mulheres com Endometriose

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