Endometriosis is a lifelong condition that can cause dysmenorrhea, infertility and chronic pain. Yet, beyond these hardships is the often-overlooked toll this disease can take on an individual's mental health.
Now, more research is helping to illuminate the link between endometriosis and depression, as well as other mental health conditions, such as anxiety. Clinicians can draw upon this evidence to help endometriosis patients manage their mental health, serving as a trusted resource to connect patients with appropriate counseling and services.
Can Endometriosis Cause Anxiety or Depression?
The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain, dyspareunia and infertility. Patients may also experience high levels of anxiety, depression and other psychiatric disorders. They may report a poorer quality of life and may struggle to get a restful night's sleep.
Even though rapid diagnosis of endometriosis remains a clinical goal, it is common for patients to go years before receiving clinical confirmation. These delays are likely to compound their mental distress.
Although endometriosis is commonly categorized into four stages, the severity of a person's discomfort or anxiety doesn't necessarily correspond to the stage of the disease, according to research published in the International Journal of Environmental Research and Public Health. OB/GYNs may encounter patients with moderate forms of the disease, but significant emotional strife.
Although treatment approaches vary, the focus is frequently on pain management, fertility preservation, quality-of-life improvement and prevention of recurrence. However, a whole-patient approach also creates space for a clinician to address the mental health burden of endometriosis.
Is There a Link Between Chronic Pain and Mental Health?
More research is needed to fully understand the role of chronic pain — a punishingly common symptom of endometriosis — in mental health. A 2019 meta-analysis in the American Journal of Obstetrics and Gynecology revealed that chronic pain was the primary factor linking endometriosis and depression. After reviewing two dozen studies encompassing 99,614 women, the research team also saw more depressive symptoms in women with endometriosis than those without it.
Similarly, a controlled study from the Journal of Psychomatic Obstetrics and Gynaecology reported that endometriosis patients with pelvic pain experienced "a poorer quality of life and mental health than those with asymptomatic endometriosis" and women without the condition.
A growing body of evidence suggests an endometriosis patient's mental health condition might amplify pain symptoms. This traps patients in a vicious cycle; their mental distress worsens their chronic pain, which then prompts greater mental anguish, and so on.
These findings mean that clinicians should regard chronic pelvic pain as an important component of endometriosis that significantly affects patients' quality of life and psychological well-being. Given this, timely detection and treatment of anxiety and depressive symptoms are warranted to proactively address mental wellness in this population.
Are Your Patients Experiencing Depression?
A multidisciplinary clinical team writing in the International Journal of Women's Health recommends early screening of endometriosis patients for symptoms of depression. The screening, they note, is one step in a fuller, integrated whole-patient treatment approach. "The aim," the authors conclude, "should be to reduce as much as possible the impact of endometriosis on quality of life and psychological well-being of these patients."
Guidelines from the United Kingdom's National Institute for Health and Clinical Excellence advise clinicians to ask women with endometriosis two simple screening questions to gauge their psychological well-being:
- "During the last month, have you often been bothered by feeling down, depressed or hopeless?"
- "During the last month, have you often been bothered by having little interest or pleasure in doing things?"
Thus far, professional societies in the U.S. have yet to issue guidelines to identify patients with endometriosis and depression or anxiety. However, the U.S. Preventive Services Task Force (USPSTF) is currently drafting new recommendations for screening for depression, anxiety and suicide risk in adults in primary care settings. Among the recommendations that USPSTF is considering is the role of collaborative care in ensuring appropriate diagnosis, treatment and improved mental health outcomes.
For patients showing signs of mental distress, a referral relationship with local therapists and psychiatrists can connect them to timely, appropriate treatment. This type of network can help ensure patients receive care that addresses the entirety of their condition.
Endometriosis requires an individualized, multidisciplinary management plan to address a patient's physical and emotional well-being. Awareness of the multifaceted relationship between mental health and the disease informs a patient-centered approach.
