Endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus. The most common symptom is severe pelvic pain during menstruation or intercourse, and it can also cause infertility and digestive issues. Around 10%-15% of women of reproductive age—approximately 190 million people worldwide—are affected by the disease.
While the cause of endometriosis remains unclear, recent research suggests that mental health may play a role in increasing the risk of developing the condition.
Our study, published in JAMA Psychiatry in February 2025, found that women with endometriosis experienced higher rates of traumatic events and stressful experiences, both in childhood and adulthood, compared to women without the disease.
We based our research on clinical and genetic data from nearly 250,000 women in the UK Biobank, which included over 8,000 endometriosis patients. We also analyzed genetic data from the FinnGen Project and several other cohorts, totaling over 500,000 women, including more than 30,000 with endometriosis.
Types of Trauma Associated with Endometriosis
The UK Biobank data revealed that women with endometriosis were more likely to have experienced adult sexual assault, life-threatening diagnoses, or witnessed sudden death. When we categorized the types of trauma, we found an increased risk of contact trauma, childhood abuse, non-interpersonal trauma, and non-contact trauma in women with endometriosis.
Further analysis showed distinct trauma groupings. A higher percentage of women with endometriosis had emotional/physical trauma (8%) or sexual trauma (5%) compared to women without the condition (5% and 4%, respectively). Additionally, 24% of women without endometriosis were placed in the “no trauma” group, compared to 20% of women with the disease.
Endometriosis was also genetically linked to posttraumatic stress disorder (PTSD) and childhood maltreatment. These findings were consistent across different cohorts.
Interestingly, our study revealed that both traumatic events and genetic factors independently contribute to the risk of developing endometriosis. This suggests that trauma and genetics may combine to increase the likelihood of developing the disease.
Trauma and Physical Health
Endometriosis is increasingly recognized as a systemic condition, meaning it impacts multiple biological systems beyond the reproductive organs. Trauma has been linked to several health issues, including cancer and heart disease.
Although few studies have explored the connection between trauma and endometriosis, there is evidence of biological mechanisms underlying this relationship. Stress responses to trauma can trigger inflammation in the body, which could contribute to the development of endometriosis.
Trauma can also disrupt hormonal balance by increasing stress hormones like cortisol. These hormonal changes may worsen endometriosis symptoms or influence its development by affecting estrogen levels.
Additionally, trauma can have lasting effects on epigenetics, which may influence immune responses, inflammation, and hormonal regulation, all of which could contribute to the disease.
The Importance of Trauma-Informed Care
Understanding the connection between trauma and endometriosis highlights the need for comprehensive care that addresses both physical and mental health. Trauma-informed care is an approach that recognizes the impact of traumatic experiences and creates a safe and supportive environment for patients. This approach is particularly crucial in gynecology, where exams often involve sensitive areas of the body.
For individuals with a history of trauma, especially sexual or physical trauma, a gynecological exam can be retraumatizing. This can discourage patients from seeking care, potentially delaying diagnosis and treatment, which already takes years for many endometriosis patients. The delay between symptom onset and diagnosis can range from 4 to 11 years.
Our study underscores the important role mental health plays in the development and progression of endometriosis. By focusing on the impact of traumatic events, we can better understand how mental health factors contribute to clinical outcomes for women with this condition.
Related topics:
