Endometriosis is a chronic and systemic inflammatory disease where endometrial uterine tissue grows out of the uterus.
The most common symptom is weakening pelvic pain before and during menstruation, or during sexual intercourse. It can also cause infertility and digestive problems, such as painful intestinal movements, among many other symptoms. Worldwide, it affects an amazing 10-15 percent of female people of reproductive age: around 190 million people.
Despite their prevalence, researchers have not yet found a definitive cause of endometriosis. However, our research contributes to a growing body of evidence that suggests that mental health can contribute to greater risk.
Our study, published in Jama Psychiatry in February 2025, found that women with endometriosis reported traumatic experiences and stressful events, both in childhood and adulthood, at a higher rate than those who do not have the disease.
We base our research on clinical and genetic information available from almost 250,000 female participants registered in the United Kingdom biobank, which included more than 8,000 patients with endometriosis. We combine this information with genetic data from the Finngen project and several other cohorts: a total of more than 500,000 women, which included more than 30,000 cases of endometriosis.
In the data of the United Kingdom Biobanco, we find that patients with endometriosis were more likely to inform to experience sexual aggression as an adult, receive a potentially deadly diagnosis or have witnessed sudden death. When we group traumatic events into categories, we found that endometriosis was associated with a greater probability of experiencing a contact trauma, child abuse, non -interpersonal trauma and contactless trauma.
In addition, our analysis found clear groups based on patterns of traumatic experiences. A higher percentage of women with endometriosis was grouped into categories based on emotional/physical trauma (8 percent) and sexual trauma (5 percent) compared to women without the disease (5 percent and 4 percent, respectively).
Women without endometriosis were more likely to be placed in the group without trauma (24%) compared to those with the disease (20 percent).
Endometriosis was also genetically related to posttraumatic stress disorder and child abuse. Other features related to trauma and observed estimates were consistent between cohorts with different characteristics.
Interestingly, we find that traumatic events and genetic factors can contribute independently to the risk of developing endometriosis. This means that genetic risk factors and traumatic experiences affect the probability of developing the disease differently and potentially compound.
A growing number of studies highlights the fact that endometriosis is systemic, which means that it is not limited to an area and affects biological systems outside the reproductive organs. In fact, trauma is related to a variety of health conditions, including cancer and heart disease.
While few studies to date have reported associations between traumatic events and endometriosis, some research has been carried out in the different types of trauma and biological mechanisms that support the relationship.
Several dynamics could explain the association between trauma and endometriosis. For example, responses to stress to traumatic experiences can trigger inflammation in the body, which then contributes to the development of endometriosis.
Trauma can also interrupt hormonal balance, especially by increasing stress hormones such as cortisol. These hormonal changes can worsen the symptoms of endometriosis or influence their development by affecting estrogen levels.
Trauma can also have long -term effects on epigenetics, influence immune responses, inflammation and hormonal regulation, all of which could contribute to the development or worsening of endometriosis.
The interaction between trauma and endometriosis highlights the importance of evaluating the physical and mental health of affected patients. This can help provide more comprehensive and effective treatment.
The attention informed by trauma is a medical care approach that supports and recognizes the impact that traumatic events have on people. It focuses on creating a security, trust and empowerment environment for people who have experienced trauma, understanding that past trauma can affect the way they interact with services or respond to attention.
The attention informed by trauma is particularly important in gynecology, where exams often involve sensitive areas of the body. For people who have experienced trauma, especially sexual or physical trauma, gynecological examination can be a potentially traumatizing experience that discourages them from looking for attention in the future.
This can even delay even more diagnosis and treatment, which is already a long process for patients with endometriosis. They often face a delay of 4 to 11 years before receiving adequate attention.
Our study expands the evidence that supports the important role of mental health in the systemic nature of endometriosis. In particular, our efforts to dissect the impact of traumatic events open new paths to understand how psychiatric risk factors can lead to negative clinical results in women.
Dora Koller is a postdoctoral researcher in women's health at the University of Barcelona, Spain. Renato Polimanti is the associate professor of psychiatry, epidemiology of chronic diseases and biomedical computer science and data science at Yale University, United States. This article is published again from the conversation under a Creative Commons license. Read the Original article
