Endometriosis affects about 190 million women worldwide, approximately one in ten of reproductive age. Yet, its true impact goes far beyond physical symptoms. Traditionally classified as a gynecological disease due to its hallmark symptoms, chronic pelvic pain, dysmenorrhea, and infertility, current consensus now recognizes endometriosis as a systemic and complex condition (Taylor et al., 2021), also affecting mental health and social well-being (Missmer et al., 2021).

Emerging research reveals that endometriosis is associated with significantly higher rates of depression, anxiety (Koller et al., 2023), and low quality of life (Missmer et al., 2021). According to a large-scale epidemiological study, women with endometriosis are three times more likely of being diagnosed with depression, anxiety, or eating disorders compared to those without the disease (Koller et al., 2023). This compounded risk is partly due to the chronic pain and flair-ups, but also to diagnostic delays. On average, it takes seven to ten years to receive an accurate diagnosis, which increases feelings of invalidation and social isolation (Missmer et al., 2021).

The relationship between endometriosis and mental health is complex and bi-directional, involving both genetic and environmental factors. Genetic studies indicate that certain DNA variants increase susceptibility to both endometriosis and psychiatric disorders (Adewuyi et al., 2021; Koller et al., 2023). At the same time, adverse childhood experiences, such as abuse or neglect, and chronic stress may disrupt immune and neuroendocrine function, further increasing vulnerability and worsening symptoms (Gonzalez, 2013). This convergence of factors, which includes chronic inflammation and neuroimmune responses, helps explain why the burden of endometriosis cannot be separated from psychological health (Koller et al., 2025).

The impact is not merely individual. Endometriosis imposes substantial societal costs, with over two-thirds of patients reporting lost productivity linked directly to their mental and physical health challenges (Missmer et al., 2021). Many studies report significantly lower life satisfaction when living with endometriosis compared to the average in the Western world (Rush & Misajon, 2018).

Evidence points clearly toward the need for integrated, trauma-informed care, an approach that recognizes the links between chronic pain, mental health, and social context (Hurley, Elle, 2021; Koller et al., 2025). Such care embraces regular screening for psychological distress, recognition of trauma histories, and collaboration across healthcare disciplines (Grossman et al., 2021). While advances in genomics and epidemiology offer better understanding, true progress will require the healthcare system to address both body and mind.

References

• Adewuyi, E. O., Mehta, D., Sapkota, Y., International Endogene Consortium, Sapkota, Y., Yoshihara, K., Nyegaard, M., Steinthorsdottir, V., Morris, A. P., Fassbender, A., Rahmioglu, N., De Vivo, I., Buring, J. E., Zhang, F., Edwards, T. L., Jones, S., Dorien, Peterse, D., Rexrode, K. M., … Nyholt, D. R. (2021). Genetic analysis of endometriosis and depression identifies shared loci and implicates causal links with gastric mucosa abnormality. Human Genetics, 140(3), 529–552. https://doi.org/10.1007/s00439-020-02223-6
• Gonzalez, A. (2013). The impact of childhood maltreatment on biological systems: Implications for clinical interventions. Paediatrics & Child Health, 18(8), 415–418.
• Grossman, S., Cooper, Z., Buxton, H., Hendrickson, S., Lewis-O’Connor, A., Stevens, J., Wong, L.-Y., & Bonne, S. (2021). Trauma-informed care: Recognizing and resisting re-traumatization in health care. Trauma Surgery & Acute Care Open, 6(1), e000815. https://doi.org/10.1136/tsaco-2021-000815
• Hurley, Elle. (2021, August 12). Trauma-informed Care Should Be the Medical Standard. Endometriosis Foundation of America.
• Koller, D., Løkhammer, S., Goroshchuk, O., Denner, V., Stiltner, B., Mitjans, M., He, J., Taylor, H. S., Lawn, R. B., Koenen, K. C., & Polimanti, R. (2025). Observational and Genetic Analyses of Traumatic Experiences and Endometriosis. JAMA Psychiatry, 82(4), 386–394. https://doi.org/10.1001/jamapsychiatry.2024.4694
• Koller, D., Pathak, G. A., Wendt, F. R., Tylee, D. S., Levey, D. F., Overstreet, C., Gelernter, J., Taylor, H. S., & Polimanti, R. (2023). Epidemiologic and Genetic Associations of Endometriosis With Depression, Anxiety, and Eating Disorders. JAMA Network Open, 6(1), e2251214. https://doi.org/10.1001/jamanetworkopen.2022.51214
• Missmer, S. A., Tu, F. F., Agarwal, S. K., Chapron, C., Soliman, A. M., Chiuve, S., Eichner, S., Flores-Caldera, I., Horne, A. W., Kimball, A. B., Laufer, M. R., Leyland, N., Singh, S. S., Taylor, H. S., & As-Sanie, S. (2021). Impact of Endometriosis on Life-Course Potential: A Narrative Review. International Journal of General Medicine, Volume 14, 9–25. https://doi.org/10.2147/IJGM.S261139
• Rush, G., & Misajon, R. (2018). Examining subjective wellbeing and health-related quality of life in women with endometriosis. Health Care for Women International, 39(3), 303–321. https://doi.org/10.1080/07399332.2017.1397671
• Taylor, H. S., Kotlyar, A. M., & Flores, V. A. (2021). Endometriosis is a chronic systemic disease: Clinical challenges and novel innovations. The Lancet, 397(10276), 839–852. https://doi.org/10.1016/S0140-6736(21)00389-5

Dora Koller

Postdoctoral fellow at the University of Barcelona and a research affiliate at Yale University. Her research focuses on the genetic overlap between psychiatric traits and physical health, with a particular interest in chronic pain and endometriosis. She investigates shared biological mechanisms to identify clinically actionable findings that can inform prevention and personalized treatment strategies. She is especially committed to advancing  women’s health research through translational and interdisciplinary approaches.