Let me start by saying I have no personal experience of endometriosis and mental health issues caused by having this medical condition. I’m a cis mixed ethnicity Black man. So I hope me writing this article doesn’t offend anyone. If it does, please let me know in the comments below. Also, please forgive me for the title. I was trying to create one that was inclusive as much as possible and still allowed for a so-so SEO score.
I wanted to tackle this topic because far too often health and mental health concerns are often steered towards a White male perspective. Plus, this is a topic that everyone needs to be able to talk about, so those who need the support get it.
I got the inspiration from doing this article after randomly seeing a tweet on Twitter.
Progress 💪 pic.twitter.com/Px1EIIquKn— Alice Pelton (@alicepelton) August 9, 2022
What Is Endometriosis?
According to Endometriosis UK, endometriosis (pronounced en-doh-mee-tree-oh-sis) is a condition where cells similar to those found in the lining of the womb (uterus) grow elsewhere in the body. Endometriosis is an estrogen-dependent disorder (Rogers et al., 2009), meaning that the amount of estrogen you produce will affect this disorder.
The problem with this uterine tissue being found elsewhere in your body is that it acts like regular uterine tissue during a period. This means the tissue breaks down and bleeds at the end of the cycle, accept it has nowhere to go, which can cause surrounding areas to become inflamed or swollen (WebMD). That doesn’t mean everyone with endometriosis will develop issues with swelling as a result of uterine tissue elsewhere in the body.
Endometriosis, also known as “endo,” is most often found in several specific areas, which according to Women’s Health are:
- The ovaries.
- The fallopian tubes.
- In the tissues that hold the uterus in place.
- Plus, outer surface of the uterus.
They can also be found in the following areas:
- The vagina.
- The cervix.
- The vulva.
- The bowel
- The bladder.
- The rectum.
In very rare cases, they can also be found in the following:
- The lungs.
- The brain.
- The skin.
Endometriosis affects around 10% of people born female in the reproductive-age group, growing to 30-50% in people with infertility and/or pain (Rogers et al., 2009). That’s roughly 190 million reproductive aged people born female, globally (Zondervan, Becker, and Missmer, 2020). Because of this, it can have a negative impact on the person’s physical health, mental health, and social wellbeing (Rogers et al., 2009).
Symptoms And Signs
Because of the high prevalence of endometriosis, it’s good to know what the signs are as it can affect fertility. All too often, people overlook these signs and ascribe them to just being part of their menstrual cycle. Enduring the pain when they could get help to manage it.
So what are the signs and symptoms of endometriosis?
- According to the Mayo Clinic, painful periods, also known as dysmenorrhea, could be a sign of endometriosis. This is when you experience pelvic pain and cramping, which may begin before and last for several days into a period.
- You may experience lower back and abdominal pain during your period (WebMD).
- Nausea, which gets worse during your periods.
- If you experience pain during sexual intercourse or after having sex (EndoFound).
- Bloating, which gets worse during your periods.
- You might feel pain urinating or having a bowel movement during your period (Mayo Clinic).
- Diarrhoea or constipation, which gets worse during your periods.
- Another sign might be that you feel fatigue (EndoFound).
- If you have occasional heavy periods or bleeding between your periods (intermenstrual bleeding), then this could be a sign of endometriosis (Mayo Clinic).
- It’s possible to be asymptomatic with endometriosis, which can mean you might not know you have it until you seek help with infertility (EndoFound and Mayo Clinic). Therefore, if you’re having trouble conceiving, then this could be a sign you need to talk to your doctor and get checked for endometriosis.
Although chronic crippling pain is the most common symptom of endometriosis (EndoFound), the severity of the pain isn’t a good indicator of the extent of your condition (Mayo Clinic). That’s because you could have agonising pain, but have a mild case of endometriosis or have no pain and have an advanced case (Mayo Clinic).
Although I can’t get endometriosis, there is a risk of it being confused with one of the conditions I do have. Namely, irritable bowel syndrome (IBS). Diarrhoea is a common symptom of IBS, and I get it more times than I’d like. You can also get constipation and other digestive troubles that might feel like cramping.
The Mayo Clinic also state that it can be mistaken for pelvic inflammatory disease (PID) or ovarian cysts. So bare that in mind, in case your doctor isn’t taking your issues seriously. It’s also possible to have co-occurring disorders. Conditions like these can take a while to diagnosis, if you’re not active in talking about your health needs with your doctor.
Types Of Endometriosis
According to WebMD, there are three main types of endometriosis, based on where the uterine tissue is found outside the uterus.
- Superficial peritoneal lesion
This is the most common form of endometriosis. You’ll have lesions on your peritoneum, which is the thin film that lines your pelvic cavity.
- Endometrioma (ovarian lesion)
Cysts develop deep in your ovaries, filling with a dark fluid. Because of this, it’s sometimes called chocolate cysts.
- Deeply infiltrating endometriosis
Around 1-5% of people born female have this form of endometriosis. This type grows under your peritoneum and can affect organs near your uterus.
Endometriosis And Mental Health
As Rogers et al. (2009) said, endometriosis can have a negative impact on your mental wellbeing. Because, anyone born female who has endometriosis is at risk of developing a mental health condition, such as anxiety and depression (endometriosis.net). Endometriosis is a chronic condition that has no cure, which can have severe life-impacting symptoms, such as agonising pain, infertility, and mental health problems (WHO).
Facchin, Saita, Barbara, Dridi, and Vercellini (2018) conducted 74 qualitative interviews to get an understanding of the negative impact of endometriosis and pelvic pain. Their findings found that normalising the pain, or worse, trivialising it, caused distress and delays in diagnosis. Which is why we need to talk about this condition. They also found that painful endometriosis is associated with depression, anxiety, and poor quality of life.
According to (Laganà et al. (2017), chronic pelvic pain is the most significant variable that can led to people with endometriosis developing a mental health condition. This is because those with this chronic pelvic pain can experience a loss of quality of life, as it can affect their ability to work and socialise. How much disruption the symptoms cause will affect how much it’ll have a negative effect on their mental health. Because this will cause a person with endometriosis to feel distress (Facchin, Saita, Barbara, Dridi, and Vercellini, 2018).
A cross-sectional study, with a total of 210 patients from an Italian academic department of obstetrics and gynaecology, was conducted by Facchin et al. (2017). They found that pelvic pain severity from endometriosis has a negative effect on people’s mental health. What’s more, they also found that other factors besides pelvic pain can affect the mental health of people with endometriosis.
Support for these studies comes from Facchin et al. (2015), who found that the pelvic pain experienced by people with endometriosis had a poorer quality of life and mental health. These conclusions were found by comparing them with people with asymptomatic endometriosis and the healthy people without the disorder.
Not only can endometriosis cause mental health problems to develop, the severity of symptoms can be affected by psychological factors. High levels of anxiety and depression can amplify the severity of pain of endometriosis (Laganà et al., 2017). So it’s no wonder that a systematic review and meta-analysis by van Barneveld et al. (2022), found that endometriosis is associated with depression and anxiety.
Another important finding from Facchin et al. (2017) study was how anxiety could develop in the short-term after being diagnosed with endometriosis. This is because the person has just become aware they have a chronic illness with no cure that can affect fertility. I know I’ve experienced something similar when getting some of my health diagnoses.
Getting an endometriosis diagnosis can cause people with the disorder to perceive themselves as worthless, causing the development of a poor body image (Facchin, Saita, Barbara, Dridi, and Vercellini, 2018). This is especially true if it makes it difficult to enjoy sex. This is why it’s important to make a psychological intervention an important part of someone’s treatment. Something Laganà et al. (2017) agreed with when they stressed the important of a multidisciplinary approach to identify those as risk of developing depression and anxiety. Thus, getting them the support they need.
In short, there should be an integrated patient-centred approach to medical, psychological, and sexual issues to improve treatment outcomes (van Barneveld et al., 2022). It should also reduce the risk of people developing a mental health condition because of their endometriosis diagnosis (Facchin et al., 2017).
Treatments For Endometriosis
Endometriosis can have a significant impact on a person’s life in several ways, and while there is no cure (The New York Times), with the right treatment, it can become manageable.
Verbalising your pain to empower yourself
The Endometriosis Foundation of America (or EndoFound) explains that acknowledging your feelings as valid allows you to commit to showing up for yourself. This can help as a first step towards improving your relationship with endometriosis. A good way to verbalise the pain could be to talk to an object, like an Inner Demon.
Yes, you guessed it, journalling can help here too. Is there anything journalling can’t help with? In much the same way as verbalising your pain to help empower yourself, you can write about it in your journal.
Endometriosis is a complex condition with psychological factors that can determine the severity of symptoms and the effectiveness of the treatments (Laganà et al., 2017). However, according to Facchin et al. (2017), research has shown that having good self-esteem and feelings of self-efficacy can help with coping with the symptoms and feeling less distressed by them. With self-efficacy, it’s the belief that you can manage your emotions and feelings, to deal with life events, that helps you live with endometriosis.
Emotional support from those around you, especially your intimate partner, can help people with endometriosis to restore a sense of normalcy to their lives. It allows them to reorganise their identity and find new meanings in life, which leads to positive mental health outcomes (Facchin et al., 2017). Yet another good reason why everyone needs to talk about endometriosis, and not just those who have it.
Birth control, such as the pill, can be used for reasons other than just wanting to avoid getting pregnant. Remember, endometriosis is an estrogen-dependent disorder (Rogers et al., 2009). Therefore, taking birth control that reduces estrogen can slow the growth of endometrial tissue, helping with pain (The New York Times). Given this fact and how many people born female can experience this disorder, it makes it all the more annoying that birth control is difficult to get in the US.
If you’ve not been offered therapy for your endometriosis, then maybe it’s time to request it from your doctor. If that’s not an option, see what’s available so you can get the support you need. A lot of charities offer ‘pay what you can afford’ or even free counselling services.
If your endometriosis isn’t manageable, for whatever reason, then surgery could be an option. You could get the endometriosis tissue cut away in patches (where possible) or you could have part or all of the organs affected by endometriosis removed (NHS). For example, you could get a hysterectomy to remove your womb.
Research has shown that endometriosis can lead to mental health issues in several ways. It has also shown how mental health conditions can make endometriosis worse. Like with any chronic pain, that pain will be a significant factor in mental health issues developing. Then you have the anxiety that might come with finding out you’ve got a chronic health condition and how it’s affecting your quality of life.
However, there are ways to manage endometriosis through mental health interventions, such as working to improve your self-esteem. But you can also take a medical approach to managing the condition. So don’t lose hope, you’ve got options.
Before I go, there is a Channel 5 show that talks about endometriosis, which is available until the 26/04/2026. If you’d like to watch it, you can do so by clicking here.
As always, leave your feedback in the comments section below. Also, please share your experiences with endometriosis in the comments section below as well. Don’t forget, if you want to stay up-to-date with my blog, then sign up for my newsletter below. Alternatively, get push notifications for new articles by clicking the red bell icon in the bottom right corner.
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Unwanted Life readers.
van Barneveld, E., Manders, J., van Osch, F., van Poll, M., Visser, L., van Hanegem, N., Lim, A. C., Bongers, M. Y., & Leue, C. (2022). Depression, Anxiety, and Correlating Factors in Endometriosis: A Systematic Review and Meta-Analysis. Journal of women’s health (2002), 31(2), 219–230. Retrieved from https://doi.org/10.1089/jwh.2021.0021 and https://d197for5662m48.cloudfront.net/documents/publicationstatus/47021/preprint_pdf/4cd2a88bf33d2a41a9f9a175fa9022a1.pdf.
Facchin, F., Barbara, G., Dridi, D., Alberico, D., Buggio, L., Somigliana, E., Saita, E., & Vercellini, P. (2017). Mental health in women with endometriosis: searching for predictors of psychological distress. Human Reproduction, 32(9), 1855-1861. Retrieved from https://academic.oup.com/humrep/article/32/9/1855/4055583.
Facchin, F., Barbara, G., Saita, E., Mosconi, P., Roberto, A., Fedele, L., & Vercellini, P. (2015). Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference. Journal of Psychosomatic Obstetrics & Gynecology, 36(4), 135-141. Retrieved from https://www.tandfonline.com/doi/full/10.3109/0167482X.2015.1074173, https://doi.org/10.3109/0167482X.2015.1074173, and https://assets.jeanhailes.org.au/Webinars/EDM_Impact_QOL_mental_health.pdf.
Facchin, F., Saita, E., Barbara, G., Dridi, D., & Vercellini, P. (2018). “Free butterflies will come out of these deep wounds”: A grounded theory of how endometriosis affects women’s psychological health. Journal of Health Psychology, 23(4), 538-549. Retrieved from https://air.unimi.it/retrieve/handle/2434/523230/901496/Facchin%20et%20al.%202017.pdf, https://journals.sagepub.com/doi/10.1177/1359105316688952, https://core.ac.uk/download/pdf/187973306.pdf, and https://doi.org/10.1177/1359105316688952.
Laganà, A. S., La Rosa, V. L., Rapisarda, A. M. C., Valenti, G., Sapia, F., Chiofalo, B., Rossetti, D., Frangež, H. B., Bokal E. V., & Vitale, S. G. (2017). Anxiety and depression in patients with endometriosis: impact and management challenges. International journal of women’s health, 9, 323. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440042.
Rogers, P. A., D’Hooghe, T. M., Fazleabas, A., Gargett, C. E., Giudice, L. C., Montgomery, G. W., Rombauts, L., Salamonsen, L. A., & Zondervan, K. T. (2009). Priorities for endometriosis research: recommendations from an international consensus workshop. Reproductive sciences (Thousand Oaks, Calif.), 16(4), 335–346. Retrieved from https://doi.org/10.1177/1933719108330568 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682634.
Zondervan, K. T., Becker, C. M., & Missmer, S. A. (2020). Endometriosis. The New England journal of medicine, 382(13), 1244–1256. Retrieved from https://doi.org/10.1056/NEJMra1810764 and https://ora.ox.ac.uk/objects/uuid:0b4cfc1d-79e9-4bee-8a4d-76ed21fa986f/download_file?safe_filename=Zondervan_et_al_Endometriosis_VoR.pdf&type_of_work=Journal+article.