- Endometriosis is a complex condition that impacts both physical and mental health.
- Women with endometriosis have a higher risk of depression, anxiety, and eating disorders.
- The association between endometriosis and depression is not just because of chronic pelvic pain.
- Promoting early diagnosis and prioritizing comprehensive can can significantly improve quality of life.
Endometriosis is a medical condition that affects some women. It happens when the tissue that normally lines the inside of the uterus (called the endometrium) starts to grow outside the uterus in places it shouldn't be.
During a woman's menstrual cycle, the endometrial tissue inside the uterus thickens and sheds if no pregnancy occurs. But with endometriosis, the tissue growing outside the uterus also behaves similarly. However, because it has no way to leave the body like menstrual blood, it becomes trapped and can cause various problems.
Regrettably, there are numerous misconceptions surrounding endometriosis, even among healthcare professionals. Diagnosis of the condition often takes a prolonged period, averaging around ten years in the United States, and the current diagnostic methods can be invasive.
Endometriosis presents with a wide range of symptoms, including severe pelvic pain, painful periods, pain during intercourse, constipation, painful urination, diarrhea, bloating, nausea, fatigue, and, in some cases, difficulty getting pregnant. The severity of symptoms can vary significantly from person to person. Alarmingly, approximately 1 in 10 women of reproductive age worldwide suffer from endometriosis.
Traditionally considered a gynecological issue, recent research indicates that endometriosis affects the entire body, including the brain. A comprehensive study conducted by researchers at Yale School of Medicine analyzed data from more than 8,200 women with endometriosis and 194,000 healthy controls (1). This study revealed a significant link between endometriosis and psychiatric conditions, such as depression, anxiety, and eating disorders. Importantly, this association persisted even after accounting for factors like chronic pain, age, socioeconomic status, body mass index, use of various medications—including birth control—and other coexisting conditions.
In terms of cause and effect, according to a longitudinal study based on a Swedish nationwide cohort of women, the association between endometriosis and both depression and anxiety is bi-directional, while the relationship with eating disorders is unidirectional.
Unfortunately, many gynecologists myopically address the disorder by focusing on reproductive areas. The medical system might even patronize women with the disease when they complain of depressive and/or anxiety symptoms.
Some doctors, for example, might tell patients that these psychiatric symptoms are because of the associated chronic pain. It is true that chronic pain can give rise to depression. However, in the Yale study, the disorder was still related to depression, anxiety, and eating disorders even after controlling for chronic pain. Thus, there is some mechanism other than chronic pain that is diminishing mental wellness for these women. A significant percentage of endometriotic women show moderate to severe anxiety symptoms and depression (29 and 14.5 percent, respectively); other studies have also shown that the disease is associated with poor quality of life (3)
The Yale group also conducted a genome-wide analysis to identify shared genes. They found that a specific genetic variant was linked to both endometriosis and depression. This gene is indirectly related to the production of estradiol (4), the primary hormone responsible for disease progression (5).
A holistic approach is essential to provide better care for women with endometriosis. Gynecologists should receive comprehensive training to recognize how reproductive system pathologies can have systemic effects on the body. Early diagnosis and less invasive diagnostic methods should be emphasized to avoid unnecessary delays in treatment. Moreover, further research should be prioritized to explore alternative treatment and prevention approaches that aim to improve the quality of life for these women.
Resources, such as support groups, should be readily available to validate the experiences and challenges faced by women with endometriosis. Regardless of age, socioeconomic status, or body mass index, their genetic predisposition may put them at a higher risk for psychiatric conditions.
If you are a woman dealing with endometriosis, it is crucial to know that your pain is genuine and deserves proper attention and understanding from healthcare providers. A compassionate and comprehensive approach can significantly improve the quality of life for those living with endometriosis.
In conclusion, endometriosis is a complex condition that impacts both physical and mental health. Recognizing its broader implications and the link with psychiatric conditions is crucial. By raising awareness, promoting early diagnosis, and prioritizing comprehensive care, we can support and empower women living with endometriosis to lead healthier and happier lives.
(1) Koller D. et al. Epidemiologic and Genetic Associations of Endometriosis With Depression, Anxiety, and Eating Disorders. JAMA Netw Open. 2023;6(1):e2251214. doi:10.1001/jamanetworkopen.2022.51214
(2) Gao M. et al. Psychiatric comorbidity among women with endometriosis: nationwide cohort study in Sweden. Am J Obstet Gynecol. 2020;223(3):415.e1-415.e16. doi:10.1016/j.ajog.2020.02.033
(3) Pope C. J., et al. systematic review of the association between psychiatric disturbances and endometriosis. J Obstet Gynaecol Can2015 37111006101526629721
(4) Filigheddu N, Sampietro S, Chianale F, et al. Diacylglycerol kinase α mediates 17-β-estradiol-induced proliferation, motility, and anchorage-independent growth of Hec-1A endometrial cancer cell line through the G protein-coupled estrogen receptor GPR30. Cell Signal. 2011;23(12):1988-1996. doi:10.1016/j.bbamcr.2014.11.011
(5) Gaskins AJ, Wilchesky M, Mumford SL, et al. Endogenous reproductive hormones and C-reactive protein across the menstrual cycle: the BioCycle Study. Am J Epidemiol. 2012;175(5):423-431. doi:10.1093/aje/kwr343