Psychological Stress in Endometriosis

Numerous studies highlight that endometriosis induces physical symptoms and imposes a significant psychological toll on those living with the condition. As a result, the quality of life of the affected individuals is often diminished, and their stress levels are heightened [3, 4, 9, 10, 17]. It is crucial to emphasize that endometriosis is not a psychosomatic ailment and does not stem from psychological issues. Instead, it signifies that women grappling with endometriosis must confront more challenges in their daily lives than their healthy counterparts. These challenges are not imagined but very tangible, impacting various facets of life. Regrettably, they can also exacerbate certain mental health conditions, leading to a higher prevalence than healthy women. Given this, it becomes even more imperative for the healthcare system to address these stressors proactively.

Symptom Burden

The initial burden of endometriosis often stems from the prolonged uncertainty until diagnosis. Research indicates that the average time from symptom onset to diagnosis ranges between 5 and 9 years [3]. Longer diagnostic delays are associated with a notable decline in quality of life.

Several factors contribute to this situation. The prevalence of chronic pain significantly curtails the quality of life for women grappling with endometriosis  [3,4]. Beyond pain, endometriosis introduces a host of additional symptoms that complicate everyday life. For instance, fatigue, which afflicts approximately 50-70% of women with endometriosis, is often severe and profoundly restrictive. Moreover, nearly half of those affected report experiencing sleep disturbances [8]. These sleep disruptions, in turn, exacerbate the erosion of both quality of life and energy levels.

Endometriosis-associated symptoms, including abdominal pain and discomfort during sexual intercourse, can markedly impact the sexuality of affected individuals. Studies have unveiled a decrease in the frequency of sexual activity, mainly linked to the severity of pain experienced. The intricate interplay of pain often leads to diminished sexual satisfaction [18,21]. This sexual struggle subsequently ripples into the realm of partnership, tarnishing the quality of life [5,13]. Notably, a survey involving 931 women revealed that 50% believed their relationships were affected by endometriosis [4]. Elements such as pain during intercourse [7], reduced sexual interest, bleeding during intimacy, fertility challenges, mood fluctuations, and fatigue contribute to this dynamic [5]. Moreover, it is not solely the affected women who feel the impact; their partners are also significantly influenced by the condition [13].


Causes – Stress Due to Effects of the Condition

The impact of the condition can extend to various aspects of the social environment [5, 15]. Approximately 19% to 48% of those affected report limitations in their social life and social activities [3,8]. Darüber hinaus nehmen Betroffene eine Stigmatisierung der Erkrankung wahr, und scheuen deshalb davor zurück in ihrem Umfeld über ihre Erkrankung zu sprechen [16].

Likewise, self-esteem and body image might be influenced among individuals with endometriosis [6,11]. However, there is limited research available on this subject.

Furthermore, the condition can have implications for performance and work life. In one study, about half of the participants indicated that endometriosis impacted their work-life [4]. Another study involving 810 individuals with endometriosis reported decreased productivity [19]. On average, they experienced a loss of 1.1 hours per week due to absenteeism and 5.3 hours due to reduced work performance. Similarly, they missed 2.5 hours in their personal lives due to reduced performance. In another study, those with endometriosis lost an average of 10.8 hours of productive time per week for health-related reasons, significantly more time than healthy women. The severity of endometriosis and its symptoms correlated with a higher reduction in productivity [12]. Consequently, endometriosis can impose a notable financial burden as well.

Frequency of Psychological Impact

Given the many stresses that endometriosis can impose, it is unsurprising that it is linked to a heightened risk of mental health disorders such as depression and anxiety. Despite this well-established connection, the precise prevalence of mental health symptoms among individuals with endometriosis remains unclear due to inconsistent findings in existing studies [1, 2, 17].

Pain appears to be a significant contributing factor in this context. For instance, one study discovered that depression affected 38% of women without chronic lower abdominal pain, while the figure rose to 86% among those experiencing chronic lower abdominal pain [9]. In another survey involving 104 women with endometriosis, approximately 86.5% exhibited varying degrees of depressive symptoms, and 87.5% displayed different degrees of anxiety. The severity of pain correlated with the intensity of anxiety symptoms, although no link was established between the stage of endometriosis and mental health [17].

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The Interplay Between Pain and Mental Well-Being

The intensity of pain appears to play a pivotal role in this context. This aligns with the findings from a survey involving 57 endometriosis patients, wherein chronic lower abdominal pain was once again linked to diminished quality of life and heightened psychological challenges. Interestingly, beyond the influence of pain, endometriosis no longer exhibited an additional impact on the quality of life [20]. When women experiencing chronic pain from endometriosis were compared with those facing chronic abdominal pain due to other conditions, no discrepancies were observed regarding depressive symptoms and emotional distress [14].

Taken together, women with endometriosis and its associated pain seem to report elevated anxiety and depressive symptoms compared to healthy women or those without pain.

While more research is necessary in this domain, existing studies already indicate a cyclic pattern wherein psychological issues, daily stressors, and pain coalesce to intensify one another in individuals with endometriosis patients [5,9,17]. While psychological discomfort does not cause endometriosis, this symbiotic relationship can exacerbate preexisting pain and issues like relationship conflicts.

In a Nutshell

To summarize, endometriosis profoundly impacts various facets of individuals’ lives, encompassing work, leisure, sexuality, relationships, self-esteem, and mental well-being. Notably, pain amplifies social and psychological stress in a self-perpetuating cycle. Thus, a multidisciplinary approach becomes imperative – one that addresses the medical dimensions and extends comprehensive support to those affected. This entails a spectrum of interventions, including exercise therapy, nutritional guidance, physical therapy, psychological treatments, meditation, and relaxation practices, to name a few. Nonetheless, further investigation is warranted to ensure optimal treatment in the future.


Cavaggioni G, Lia C, Resta S, Antonielli T, Benedetti Panici P, Megiorni F, et al. Are mood and anxiety disorders and alexithymia associated with endometriosis? A preliminary study. Biomed Res Int. 2014;2014:786830.
Chen L-C, Hsu J-W, Huang K-L, Bai Y-M, Su T-P, Li C-T, et al. Risk of developing major depression and anxiety disorders among women with endometriosis: A longitudinal follow-up study. J Affect Disord. 2016 Jan 15;190:282–5.
Culley L, Law C, Hudson N, Denny E, Mitchell H, Baumgarten M, et al. The social and psychological impact of endometriosis on women’s lives: a critical narrative review. Hum Reprod Update. 2013 Dec;19(6):625–39.
De Graaff AA, D’Hooghe TM, Dunselman GAJ, Dirksen CD, Hummelshoj L, WERF EndoCost Consortium, et al. The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Human Reproduction [Internet]. 2013 Oct 1 [cited 2021 Apr 15];28(10):2677–85. Available from:
Della Corte L, Di Filippo C, Gabrielli O, Reppuccia S, La Rosa VL, Ragusa R, et al. The Burden of Endometriosis on Women’s Lifespan: A Narrative Overview on Quality of Life and Psychosocial Wellbeing. International Journal of Environmental Research and Public Health [Internet]. 2020 Jan [cited 2021 Apr 15];17(13):4683. Available from:
Facchin F, Barbara G, Dridi D, Alberico D, Buggio L, Somigliana E, et al. Mental health in women with endometriosis: searching for predictors of psychological distress. Human Reproduction [Internet]. 2017 Sep 1 [cited 2021 Apr 15];32(9):1855–61. Available from:
Fagervold B, Jenssen M, Hummelshoj L, Moen MH. Life after a diagnosis with endometriosis - a 15 years follow-up study. Acta Obstet Gynecol Scand. 2009;88(8):914–9.
Fourquet J, Gao X, Zavala D, Orengo JC, Abac S, Ruiz A, et al. Patients’ report on how endometriosis affects health, work, and daily life. Fertil Steril. 2010 May 1;93(7):2424–8.
La Rosa VL, De Franciscis P, Barra F, Schiattarella A, Török P, Shah M, et al. Quality of life in women with endometriosis: a narrative overview. Minerva Med. 2020 Feb;111(1):68–78.
Laganà AS, Rosa VLL, Rapisarda AMC, Valenti G, Sapia F, Chiofalo B, et al. Anxiety and depression in patients with endometriosis: impact and management challenges [Internet]. International Journal of Women’s Health. 2017 [cited 2021 Apr 15]. Available from:
Melis, Irene & Litta, Pietro & Nappi, Luigi & Agus, Mirian & Melis, Gian & Angioni, Stefano. Sexual Function in Women with Deep Endometriosis: Correlation with Quality of Life, Intensity of Pain, Depression, Anxiety, and Body Image. International Journal of Sexual Health. 2015;27(2).
Nnoaham KE, Hummelshoj L, Webster P, d’Hooghe T, de Cicco Nardone F, de Cicco Nardone C, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011 Aug;96(2):366-373.e8.
Norinho P, Martins MM, Ferreira H. A systematic review on the effects of endometriosis on sexuality and couple’s relationship. Facts Views Vis Obgyn. 2020 Oct 8;12(3):197–205.
Roth RS, Punch M, Bachman JE. Psychological factors in chronic pelvic pain due to endometriosis: a comparative study. Gynecol Obstet Invest. 2011;72(1):15–9.
Rush G, Misajon R. Examining subjective wellbeing and health-related quality of life in women with endometriosis. Health Care for Women International [Internet]. 2018 Mar 4 [cited 2021 Feb 25];39(3):303–21. Available from:
Seear K. The etiquette of endometriosis: stigmatisation, menstrual concealment and the diagnostic delay. Soc Sci Med. 2009 Oct;69(8):1220–7.
Sepulcri R de P, do Amaral VF. Depressive symptoms, anxiety, and quality of life in women with pelvic endometriosis. Eur J Obstet Gynecol Reprod Biol. 2009 Jan;142(1):53–6.
Shum LK, Bedaiwy MA, Allaire C, Williams C, Noga H, Albert A, et al. Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis. Sex Med. 2018 Sep;6(3):224–33.
Soliman AM, Coyne KS, Gries KS, Castelli-Haley J, Snabes MC, Surrey ES. The Effect of Endometriosis Symptoms on Absenteeism and Presenteeism in the Workplace and at Home. J Manag Care Spec Pharm. 2017 Jul;23(7):745–54.
Souza CA, Oliveira LM, Scheffel C, Genro VK, Rosa V, Chaves MF, et al. Quality of life associated to chronic pelvic pain is independent of endometriosis diagnosis--a cross-sectional survey. Health Qual Life Outcomes. 2011 Jun 10;9:41.
van Poll M, van Barneveld E, Aerts L, Maas JWM, Lim AC, de Greef BTA, et al. Endometriosis and Sexual Quality of Life. Sex Med. 2020 Sep;8(3):532–44.
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