By Grace Schreffler, M.Ed., Registered Mental Health Counselor Intern
Endometriosis is a gynecological condition characterized by the presence of tissue similar to that of the uterine lining growing in places outside of the uterus. Its prevalence is staggeringly common. It is estimated that up to 1 in 10 women in the United States have the condition and that globally, 10% of women and girls of reproductive age have endometriosis.
There is a diverse presentation of the condition, but the primary and most significant symptom ispain. And herein lies its likely connection to mental health.
Researchers are finding a link between endometriosis and mental health challenges such as depression, anxiety, and sexual dysfunction.
What does this sound like?
Anxiety: “Why am I in so much pain? What is causing this? Do I need to go to the emergency room?”
“What if I get the surgery and they don’t find everything? What if I am making it all up?”
Depression: “I’m 6 months post-excision surgery and my endometriosis has already returned. The optimism I kept holding onto is starting to wither- I’m trying so hard but I’m starting to lose hope”
“The pain gets so bad I just wish I could end it all”
Sexual Dysfunction: “Sex hurts so bad- I know my partner loves me, but I feel like such a failure that I can’t enjoy sex”
“It’s so hard to be excited about sex when I know the result will be extreme pain and immobility. I hate that he feels bad for ‘hurting me’”.
How does endometriosis worsen mental health challenges?
Intensity of Pain: Life with endometriosis may mean that the person frequently experiences high degrees of pain. This can lead to something called pain catastrophizing. Pain catastrophizing is a phenomenon characterized by feelings of helplessness, emotional dysregulation, rumination, and interoceptive sensitivity. The experience of severe pain may adversely impact thoughts further exacerbating symptoms of anxiety or depression.
Chronic Nature of Pain: Chronic pain can result in something called central nervous system sensitization. This occurs when the person’s nervous system is in a constant state of activation. This activated state leads the brain to overreact to sensory input and perceive non-threatening stimuli as dangerous. This process results in more chronic pain even in the absence of threatening stimuli. The nature of chronic pain and central nervous system sensitization may impact a person’s ability to engage in social relationships. It may lead to missed work, abstaining from previously enjoyed hobbies and just an overall poorer quality of life. These factors are all likely to increase feelings of depression, anxiety, and decrease sexual satisfaction in romantic relationships.
Difficult to Diagnose: On average it takes about 7.5 years for women to be diagnosed with endometriosis. Part of this is because the symptoms of endometriosis may mimic other conditions such as irritable bowel syndrome, interstitial cystitis, or pelvic floor dysfunction. However, the availability of non-invasive diagnostic tools also presents an obstacle to diagnosis. A laparoscopy with biopsy is the only way to definitively diagnose endometriosis. No lab test can diagnose endometriosis and while evidence of the condition may be observed using MRI or ultrasound, the absence of endometriosis in imaging does not confirm a person does not have the condition. The requirement of an invasive procedure and surgery to diagnose may present as a barrier for those seeking answers, further increasing feelings of hopelessness or anxiety. While some doctors may offer a clinical diagnosis (diagnosis based on symptoms), others may be quick to dismiss a person’s symptoms as “just a bad period”. Studies that looked at healthcare and pain, indicated that providers tended to explain and dismiss women’s pain as the result of being overly sensitive when compared with men. These factors all contribute to feelings of invalidation and helplessness potentially worsening depressive and anxiety symptoms for women with the condition.
Uncertain Prognosis and Elusive Treatments: The cause for endometriosis remains unknown and there is no cure. The treatments available to women with endometriosis remain limited and often come with an array of challenging side effects which may adversely impact mental health. Although endometriosis is not a strictly gynecological or hormonal condition, hormonal birth control or GnRH antagonists (e.g. Orlissa, Lupron) are often prescribed to manage symptoms which may or may not be well tolerated. Excision surgery is considered to be the gold standard for removal of endometrial lesions, however not all individuals have access to specialists, can afford the costs of surgery, or find relief once lesions have been removed. Being diagnosed with a condition whose prognosis is unique to each individual could certainly contribute to feelings of anxiety and depression.
Endometriosis is a chronic and painful condition. The presence of intense and chronic pain in combination with barriers to diagnosis and treatment are likely the reasons for its notable impact on mental health. If you are struggling with endometriosis, it is important for you to know you’re not alone, you’re not making it up, and you are a warrior! If you notice that the condition is having an impact on your mental health don’t hesitate to reach out to a mental health professional for support.
Counseling Hoboken; Mollie Busino, LCSW, Director of Mindful Power. Mollie has had extensive training in Cognitive Behavioral Therapy, Fertility Counseling, and Post Traumatic Stress Disorder (PTSD). Her work focuses on Anxiety, Depression, Anger Management, Career Changes, OCD, Relationship, Dating Challenges, Insomnia, & Postpartum Depression and Anxiety.
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