Endometriosis and Mental Health

Introduction

Every year in the UK, it is estimated that 1 in 4 people will experience mental health problems.¹ Those suffering from chronic health conditions are at a higher risk due to the severity and difficulty in managment of the sympotms and the isolation they feel. Physical illness can negatively impact mental health, daily activities and quality of life. A long-term (chronic) condition which has shown to affect mental health is endometriosis.

What is endometriosis?

Endometriosis is a condition where the endometrium, the inner most epilthelial layer of the uterus, grows outside of the uterus causing irritation to its surroundings. The most common area where these cells can grow are the ovaries, but can also grow on your fallopian tubes, ligaments in your pelvis, or anywhere in your abdomen. Rarely, it has been known to grow on the heart, lungs and brain.²

Symptoms

Symptoms of endometriosis vary in severity and can fluctuate throughout the month in relation to your menstrual cycle. Common symptoms include: 

• Pain in the pelvic region or lower back which may worsen during
• Pain during or after sex 
• Pain whengoing to the toilet 
• Nausea, constipation, or diarrhoea during mensturation
• Infertility or difficulty conceiving
• Heavy, painful periods³

Hormonal changes affect mood

Women are twice as likely than men to suffer from mood disorders, with increased incidence from puberty up until menopause.⁴ The exact reason is unknown, but hormones play a critical role in regulating emotions.

Hormones are chemicals that help regulate important functions in your body. During your menstrual cycle, there are several key hormones that fluctuate throughout the the cycle at different stages. Due to the rise and fall of hormones, a cascade of reactions such as the release of the egg, the  formation of the lining of the womb, and subsequentally the breakdown of the lining. Oestrogen is one of hormones which contributes to the series of reactions. Outside of the menstrual cycle, oestrogen interacts with two  hormones associated with positive mood dopamine and seratonin. Research studies suggest that there is a correlation between low levels of oestorgen and depression.⁵

Endometriosis is an oestrogen-dependent disease. Unlike  the enodmetiral lining that is formed inside the womb, the tissue that  is formed outside of the womb can produce its own oestrogen. These fluctuating levels of oestrogen have been suggested to trigger mood swings, leading to depression, anxiety, and irritability. 

The burden of chronic pain

Chronic illnesses affects all aspects of life. Many women with endometriosis feel anxious regarding the uncertainty of the disease. Women feel uncertain about  the diagnosis, the symptoms, or towards the prognosis of the disease. 

In endometriosis, there are 4 different types of pain: 

• Dysmenorrhoea, pain which is felt during mernsturation
• Dyspareunia, pain during sex 
• Non-menstrual pelvic pain which is pain when not mensturating
• Dyschezia, Pain during defecation⁶

With 4 distinct types of pain, those suffering from endometriosis have difficulty managing all areas. Even after surgery, pain has been reported.⁷ Besides impacting your mental health, chronic pain can lead to substance abuse disorders, worsening of the chronic disease and increased risk of suicide.⁸

Increased rates of depression and anxiety

Inflammatory disorders have been linked to poor mental health. They can produce the ‘sickness response’, which can stimulate depression-like behaviours, such as feeling low, feeling tired, and having a negative impact on your diet and sleep pattern. Women suffering from endometriosis have higher rates of work inhibition, sexual dysfunction and dissatisfaction with their quality of life^6,9

Understanding the effect of endometriosis on mental health

Endometriosis is a life-long condition that cannot be cured. Women who suffer from it can have difficulty coming to terms with the possibility of infertilityand  potential difficulty conceiving. Chronic, cyclical pain is also a challenging burden. Many women describe medical professionals as not believing in the intensity and severity of their pain, feeling like their experience of endometriosis is belittled. However, there is evidence showing that endometriosis affects the parts of the brain that deal with pain. This can lead to increased sensitivity, making these women feel pain more intensely than others.¹⁰

Diagnosis of endometriosis is challenging and can take a long time, leading to women having to endure debilitating symptoms with little to no respite. Even after a endometriosis diagnosis, treatment can be inadequate and ineffective, with the chance of the reaccurence of the disease. Women often feel that their symptoms and experiences are not taken seriously by medical professionals and by those around them,  affecting their mental well-being.¹¹

If you’re worried about your or your loved one’s mental health

If you are concerned about your mental health, talk to your medical provider. They can help discuss your concerns about the disease and possible treatment options and coping mechanisms. 

Outside of the medical field, there are organisations in place that offer around-the-clock mental and emotional support. Some specialise in the disease, such as Endometriosis UK, which is an excellent place to seek help. They provide information and support groups to help those battling endometriosis and their families understand more about the condition and what can be done to help it. 

For general mental health concerns, charities like the Samaritans also offer 24-hour support for those who need someone to talk to. They can be reached over the phone or by an online chat service. 

Conclusion

Endometriosis can have a significant impact on your mental health. However, there are support networks available to help provide information and connect you to people with similar experiences. If you are struggling to cope with endometriosis, reach out to your doctor, your loved ones, or a support network. There is no need to suffer alone.