Women With Endometriosis May be at a Higher Risk of Physhiatric Disorders

Endometriosis May be Linked to Long-Term Risk of Psychiatric Disorders

Key Points

Highlights: 

• Endometriosis may be associated with an increased long-term risk of psychiatric disorders.
• Elevated risks are observed for depression, anxiety, and substance use disorders.
• The association varies across age and racial groups.

Importance: 

• Psychiatric comorbidity should be recognized as a clinically relevant component of endometriosis, with implications for long-term patient care.

What’s done here:

• This is a retrospective cohort study using the TriNetX U.S. Collaborative Network; includes 7,563 women with endometriosis matched 1:1 with controls.
• Endometriosis cases were identified using diagnostic codes combined with surgical procedures, providing a clinically coded, surgically enriched cohort.
• It evaluates long-term risk of psychiatric disorders over up to 20 years.
• Outcomes include depression, anxiety, substance use disorders, and related conditions.

Key results:

• Endometriosis is associated with an increased overall risk of psychiatric disorders (HR 1.38).
• Increased risks are observed for depressive episodes (HR 1.35) and anxiety disorders (HR 1.39).
• Substance use disorders are also more frequent (HR 1.43).
• Associations are more pronounced in White women, while findings in other groups are less consistent.
• Postoperative hormonal therapy does not significantly reduce psychiatric risk.

Strengths and Limitations:

• Strengths are: large real-world cohort; long follow-up period; use of propensity score matching; evaluation of multiple psychiatric outcomes.
• Limitations are: retrospective design; reliance on coded diagnoses; lack of data on disease severity, pain, and quality of life; incomplete adjustment for psychosocial confounders; limited ability to establish temporal causality.

From the Editor-in-Chief – EndoNews

"This study adds to the growing body of evidence suggesting that endometriosis extends beyond a localized gynecologic condition and is associated with long-term systemic consequences, including mental health outcomes.

By leveraging a large real-world dataset with long-term follow-up, the authors demonstrate a consistent association between endometriosis and an increased risk of several psychiatric disorders, particularly depression, anxiety, and substance-related conditions. The use of propensity score matching strengthens the comparability of cohorts, although, as with all observational designs, residual confounding cannot be excluded.

The findings are not entirely unexpected. Chronic pelvic pain, infertility, repeated interventions, and diagnostic delay are well-established contributors to psychological distress. In addition, emerging data suggest that neuroinflammatory and neuroendocrine mechanisms may play a role in linking endometriosis to mood and anxiety disorders. However, the present study does not directly address these mechanisms and should not be interpreted as evidence of a unified biological pathway.

The observed variability across racial groups is notable but requires cautious interpretation. Differences in healthcare access, diagnostic practices, cultural perceptions of mental health, and sample size imbalance may all contribute to these patterns. Therefore, the absence of statistically significant associations in certain subgroups should not be interpreted as absence of risk.

Importantly, the lack of apparent protective effect from postoperative hormonal therapy underscores a critical point: current treatment strategies for endometriosis, while targeting pain and disease recurrence, may not adequately address its broader psychological burden. This highlights a gap between disease-centered treatment and patient-centered outcomes.

At the same time, several limitations temper the conclusions. The reliance on coded diagnoses, the absence of detailed clinical variables such as pain severity or disease stage, and the inability to fully adjust for psychosocial determinants limit causal inference. The temporal relationship between endometriosis and psychiatric disorders, although suggestive, remains incompletely defined.

The association between endometriosis and psychiatric disorders appears consistent, clinically relevant, and likely multifactorial. Whether this reflects shared biological mechanisms, the cumulative burden of chronic disease, or differences in healthcare engagement remains unresolved. What is clear is that mental health cannot be considered peripheral in the care of patients with endometriosis, but rather an integral component that warrants structured and sustained attention."

Lay Summary

Endometriosis may carry implications beyond the pelvis.

A new study published in Comprehensive Psychiatry led by Dr. Chien-Hsing Lu and colleagues (Taichung Veterans General Hospital, Taiwan) suggests that women with endometriosis may have an increased long-term risk of psychiatric disorders.

Using real-world data from more than 7,500 women with endometriosis and matched controls, the authors followed patients for up to two decades. They found that endometriosis was associated with a higher risk of several psychiatric conditions, particularly depression, anxiety, and substance use disorders.

The overall risk of developing any psychiatric disorder was also increased, indicating that this association is not limited to a single condition but spans multiple domains of mental health.

The magnitude of risk varied across patient groups. Stronger associations were observed in some populations, while findings in others were less consistent, suggesting that demographic and clinical factors may influence this relationship.

Importantly, postoperative hormonal therapy did not appear to reduce the risk of psychiatric disorders, indicating that current treatment strategies may have limited impact on mental health outcomes.

While the study does not establish a causal relationship, it highlights a clinically relevant overlap between endometriosis and mental health that may warrant greater attention in long-term patient care.

Research Source: https://pubmed.ncbi.nlm.nih.gov/41308609/