Editor's Choice
PUBLIC HEALTH / SYSTEMATIC REVIEW/META-ANALYSIS
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The chronic gynecological condition endometriosis affects about 10 percent of reproductive aged women and imposes a heavy physical and psychological burden. The impact of pain and infertility is well documented, but the link between endometriosis and mental health (depressive and anxiety), in particular, is not well studied. In this systematic review and meta-analysis, we synthesize evidence on the association between endometriosis and mental health outcomes, specifically anxiety and depression.

Material and methods:
PubMed, Cochrane Library and Google Scholar were searched comprehensively to identify studies that have reported the association of endometriosis and mental health outcomes. Nine studies were included after applying predefined inclusion and exclusion criteria from 1,632 articles screened. The Newcastle-Ottawa Scale (NOS) was used to assess study quality and random effects meta-analyses were performed using R. Relative risk (RR) values for anxiety and depression among women with endometriosis were pooled as the primary outcomes.

Results:
The meta-analysis revealed a significant association between endometriosis and anxiety (pooled RR = 2.82; 95% CI: 1.69–4.68, p < 0.001) and depression (pooled RR = 2.93; 95% CI: 1.63–5.25, p < 0.001). Substantial heterogeneity was observed in both analyses (I² = 100%), reflecting variability in study designs and populations. Funnel plots showed moderate asymmetry, suggesting potential publication bias. Statistical heterogeneity was further quantified with ² values of 0.6032 for anxiety and 0.794 for depression, indicating considerable between-study variability. These findings underscore the heightened mental health burden in women with endometriosis.

Conclusions:
Endometriosis patients are more likely to develop anxiety and depressive symptoms due to pain and diagnostic evaluation and related psychosocial factors. This study stresses the importance of integrated care, which involves screening and treatment for mental health problems in addition to conventional medical care. Future work should aim to reduce heterogeneity and examine potential pathways through which these relationships exist in order to develop specific prevention strategies.
REFERENCES (30)
1.
Ahn SH, Singh V, Tayade C. Biomarkers in endometriosis: challenges and opportunities. Fertil Steril 2017; 107: 523-32.
 
2.
Lukac S, Schmid M, Pfister K, Janni W, Schäffler H, Dayan D. Extragenital endometriosis in the differential diagnosis of non-gynecological diseases. Dtsch Ärztebl Int 2022; 119: 361-7.
 
3.
Choi EJ, Cho SB, Lee SR, et al. Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis. Obstet Gynecol Sci 2017; 60: 579-86.
 
4.
Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet 2021; 397: 839-52.
 
5.
Verit FF, Yucel O. Endometriosis, leiomyoma and adenomyosis: the risk of gynecologic malignancy. Asian Pacific J Cancer Prev 2013; 14: 5589-97.
 
6.
Horne AW, Missmer SA. Pathophysiology, diagnosis, and management of endometriosis. BMJ 2022; 379: e070750.
 
7.
Kvaskoff M, Mu F, Terry KL, et al. Endometriosis: a high-risk population for major chronic diseases? Human Reprod Update 2015; 21: 500-16.
 
8.
Ghiasi M, Kulkarni MT, Missmer SA. Is endometriosis more common and more severe than it was 30 years ago? J Minim Invasive Gynecol 2020; 27: 452-61.
 
9.
Mehedintu C, Plotogea M, Ionescu S, Antonovici M. Endometriosis still a challenge. J Med Life 2014; 7: 349-57.
 
10.
Saavalainen L, Lassus H, But A, et al. Risk of gynecologic cancer according to the type of endometriosis. Obstet Gynecol 2018; 131: 1095-102.
 
11.
Acién P, Velasco I. Endometriosis: a disease that remains enigmatic. ISRN Obstet Gynecol 2013; 2013: 242149.
 
12.
Laganà AS, La Rosa VL, Rapisarda AMC, et al. Anxiety and depression in patients with endometriosis: impact and management challenges. Int J Women’s Health 2017; 9: 323-30.
 
13.
Sasson IE, Taylor HS. Stem cells and the pathogenesis of endometriosis. Ann N Y Acad Sci 2008; 1127: 106-15.
 
14.
Falcone T, Lebovic DI. Clinical management of endometriosis. Obstet Gynecol 2011; 118: 691-705.
 
15.
Márki G, Vásárhelyi D, Rigó A, Kaló Z, Ács N, Bokor A. Challenges of and possible solutions for living with endometriosis: a qualitative study. BMC Women’s Health 2022; 22: 20.
 
16.
Agarwal SK, Foster WG, Groessl EJ. Rethinking endometriosis care: applying the chronic care model via a multidisciplinary program for the care of women with endometriosis. Int J Women’s Health 2019; 11: 405-10.
 
17.
Takebayashi A, Kimura F, Kishi Y, et al. The association between endometriosis and chronic endometritis. PLoS One 2014; 9: e88354.
 
18.
Simadibrata DM, Lesmana E, Fass R. A systematic review and meta-analysis of the efficacy of vonoprazan for proton pump inhibitor-resistant gastroesophageal reflux disease. J Gastroenterol Hepatol 2024; 39: 796-805.
 
19.
Friedl F, Riedl D, Fessler S, et al. Impact of endometriosis on quality of life, anxiety, and depression: an Austrian perspective. Arch Gynecol Obstet 2015; 292: 1393-9.
 
20.
Škegro B, Bjedov S, Mikuš M, et al. Endometriosis, pain and mental health. Psychiatr Danub 2021; 33 (Suppl 4): 632-6.
 
21.
Gao M, Koupil I, Sjöqvist H, et al. Psychiatric comorbidity among women with endometriosis: nationwide cohort study in Sweden. Am J Obstet Gynecol 2020; 223: 415.e4-415.e16.
 
22.
Márki G, Bokor A, Rigó J, Rigó A. Physical pain and emotion regulation as the main predictive factors of health-related quality of life in women living with endometriosis. Human Reprod 2017; 32: 1432-8.
 
23.
Facchin F, Barbara G, Dridi D, et al. Mental health in women with endometriosis: searching for predictors of psychological distress. Human Reprod 2017; 32: 1855-61.
 
24.
Marschall H, Hansen KE, Forman A, Thomsen DK. Storying endometriosis: examining relationships between narrative identity, mental health, and pain. J Res Personal 2021; 91: 104062.
 
25.
Estes SJ, Huisingh CE, Chiuve SE, Petruski-Ivleva N, Missmer SA. Depression, anxiety, and self-directed violence in women with endometriosis: a retrospective matched-cohort study. Am J Epidemiol 2021; 190: 843-52.
 
26.
Wang TM, Lee YL, Chung CH, et al. Association between endometriosis and mental disorders including psychiatric disorders, suicide, and all-cause mortality-a nationwide population-based cohort study in Taiwan. Int J Women’s Health 2023; 15: 1865-82.
 
27.
Becker K, Heinemann K, Imthurn B, et al. Real world data on symptomology and diagnostic approaches of 27,840 women living with endometriosis. Sci Rep 2021; 11: 20404.
 
28.
Arena A, Orsini B, Degli Esposti E, et al. The unbearable burden of endometriosis: results from a large cohort about anxiety reduction during the first outpatient evaluation. J Psychosom Res 2021; 147: 110512.
 
29.
Dietrich H, Knobel C, Portmann L, et al. Endometriosis features and dienogest tolerability in women with depression: a case-control study. Eur J Contracept Reprod Health Care 2023; 28: 198-204.
 
30.
Chen LC, Hsu JW, Huang KL, et al. Risk of developing major depression and anxiety disorders among women with endometriosis: a longitudinal follow-up study. J Affect Disord 2016; 190: 282-5.
 
eISSN:1896-9151
ISSN:1734-1922
Journals System - logo
Scroll to top