The Connection Between Endometriosis and Mental Health

Anxiety and depression are two types of mental health conditions. Mental health conditions include a wide variety of disorders that affect the way a person feels, thinks, or behaves. Mental health conditions can also greatly impact an individual's mood. It is estimated that approximately 1 in 5 American adults have experienced a mental illness. This is over 43 million people in the United States alone.¹ This statistic may also be an underestimate, meaning there may be even more people living with a mental health condition or who have experienced a mental health condition, as not everyone who has or is experiencing signs of a mental health issue seek medical or professional attention. The reasons for this may vary significantly from person to person, and may be due to cultural, social, financial, or personal reasons.

Mental illness can be experienced at any point throughout life, and may be triggered by a traumatic event or personal struggle. For many though, mental illness may develop without any such experience. Examples of mental health conditions include, but are not limited to, anxiety, depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD), eating disorders, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), schizophrenia, and borderline personality disorder. Treatment options vary based on condition, however, many treatment regimens include medications or therapy.

Anxiety, or anxiety disorder, occurs when an individual's normal, healthy anxious feelings continue to grow, develop, and worsen to the point where their normal daily activities and functioning are negatively impacted. Anxiety disorders include social anxiety disorder, panic disorder, and generalized anxiety disorder.² It is estimated that over 18% of Americans have or have experienced an anxiety disorder. This is over 42 million people.¹

Depression involves experiencing a depressed, downtrodden, or sad mood for an extended period of time. Feelings of depression are similar to feelings of sadness; however, they are generally more intense and do not go away. Depression can impact an individual's desire to take part in activities they once enjoyed and can negatively affect self-esteem and self-worth. Depressive symptoms and feelings can get so intense that they cause suicidal thoughts or behaviors. Depression can take a variety of forms, including persistent depressive disorder, postpartum depression (after giving birth), psychotic depression, seasonal affective disorder, and bipolar disorder.³ Nearly 7% of Americans experience major depression. This is over 16 million people in the United States alone.¹ As mentioned previously however, these statistics, along with the statistics on anxiety disorders, may be greatly underestimating the true prevalence of these conditions.

How are anxiety and depression linked to endometriosis?

The association between endometriosis and the development of mental health conditions like anxiety and depression is one that is actively being investigated by experts in the field. Several studies have shown that endometriosis, and its related symptoms and experiences, can lead to impaired mental health and a decreased quality of life. This association has been predicted to be stronger in women who lack an understanding partner or support system, as well as in those who experience chronic and severe symptoms.^4-6 Despite this however, any woman with endometriosis, regardless of personal situation or symptoms, may be at risk for developing mental health conditions like anxiety and depression.

Some of the possible endometriosis-related factors that experts believe could lead to the development of anxiety or depression (among other mental health conditions), are chronic pelvic pain, pain during sex,infertility, time since diagnosis, age, relationship status, supportiveness of intimate partner, and self-perception or self-esteem.^4-6 As an example of how these variables may interact and lead to mental health distress, symptoms such as pain during sex, infertility, and chronic pelvic pain, may lead to a negative sense of female identity, which in turn, may impact a woman's self-esteem and self-perception. Negative self-perception or low self-esteem may then contribute to feelings of anxiety or depression.⁴

Additionally, a woman who is recently diagnosed may experience greater distress than a woman who has been diagnosed for decades. Similarly, women who are trying to have children and are diagnosed with endometriosis and have associated fertility issues may experience greater mental distress than a woman who is diagnosed after having children or who is not trying have children. However, it's important to note that these are just potential examples and that the endometriosis-mental health association is much more complex and can vary greatly from person to person. Some experts even hypothesize that mental health and physical symptoms exist together in a cycle, and that an increase in one, leads to an increase in the other. For example, chronic pelvic pain may lead to feelings of anxiety or depression, which then may affect or increase pain levels. This increase in physical pain may then continue the cycle and increase psychological symptoms again.⁵

Symptoms

Common signs of anxiety include:

• Excessive worrying
• Restlessness or feeling on edge
• Trouble sleeping
• Concentration difficulties
• Irritability
• Repetitive and sudden experiences of overwhelming fear or lack of control of one's body
• Fear or avoidance or people or places
• High levels of self-consciousness or fear of rejections, judgement, or embarrassment²

Common signs of depression include:

• Constant and intense feelings of sadness, emptiness, guilt, anxiety, or hopelessness
• Significant and constant fatigue
• Restlessness
• Trouble sleeping
• Trouble concentrating
• Loss of interest in activities and hobbies that were once enjoyable
• Changes in appetite or weight
• Physical aches, pain, or digestive issues³

This is not an exhaustive list of all possible symptoms of anxiety and depression. If you are experiencing the above issues, or notice any new or worsening symptoms, contact a healthcare provider immediately.

Diagnosis and evaluation

Diagnosing a mental health condition may take some time and involve several different experts. Diagnosis may start with a physical exam or lab tests to make sure the symptoms you're experiencing are not due to another underlying physical health condition. During, or after, this process, an individual may see a mental health professional, such as a psychologist or psychiatrist. A mental health provider will ask you about your feelings, experiences, mood, thoughts, and more, to determine if you meet the criteria for one, or more, mental health conditions. When diagnosing someone, a mental health professional will use the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) criteria for each potential condition. These criteria are created and outlined by the American Psychiatric Association.⁷

Treatment options

Once a diagnosis is made, treatment may start immediately. Treatment options can vary greatly based on the condition experienced, as well as person to person. Each individual is different, and so will be their treatment. For example, two individuals who are roughly the same age, have comparable symptoms, and have a similar background may both have depression, however, two totally different treatment regimens may provide them with relief from their symptoms. Treatment, especially with medication, is often a trial-and-error process. Common treatment options for anxiety and depression include:

• Medications including antidepressants, anti-anxiety drugs, and beta-blockers
• Psychotherapy (also called talk therapy) including cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy
• Brain stimulation treatments
• Joining a support group
• Making lifestyle changes such as exercising regularly, setting realistic goals and expectations, and postponing major life events^2,3,7

Seeking medical attention

Although it may be difficult or scary to seek medical attention for a mental health condition, it may be life-saving to address these symptoms before they worsen greatly. If you or a loved one are experiencing any or all of the above symptoms, consider seeking help as soon as possible. If you or a loved one are experiencing suicidal thoughts or behaviors, consider seeking the assistance of an immediate and emergent help organization, such as the National Suicide Prevention Lifeline at 1-800-273-8255.