How do psychological factors impact endometriosis pain?

Endometriosis is a painful condition that involves endometrial tissue growing outside of the uterus. While the endometrium tissue thickens and breaks down with every menstrual cycle, women with this disorder have blood that is unable to exit the body.

This causes several symptoms, including but not limited to painful periods (dysmenorrhea), excessive bleeding, the formation of scar tissue which can lead to pain with intercourse, pain with bowel movements or urination, and infertility. The pain associated with endometriosis can be so bad that women need daily medication, sometimes surgery and many women are managed in chronic pain programs. Infertility can result from endometriosis if tissue growth causes scarring and disrupts the fallopian tube function.

A recent Italian study states that a woman’s psychological well-being can impact the pain associated with endometriosis. The women’s internal need for control, negative emotions, depression, and self-blame can lead to increased acute pain. The study included 162 women with endometriosis, of whom 60 were recruited from a North Italy hospital and 102 from virtual support groups, medical forums, and websites. The findings showed a moderate correlation — 58% of women with higher pain scores also had the worry personality trait. Many of the participants in this group stated, “This was something I could not control, and this is the thing that bothered me the most.” The learned helplessness, or perceived lack of ability to do anything, may be increasing the intensity of the pain women experience.

WebMD elaborates and suggests a bidirectional relationship between mental health status and the severity of endometriosis, by stating that endometriosis can make one more likely to have anxiety, depression, and mental health issues. Mental health disorders can lead to an intensified experience of endometriosis pain, and cause a negative cycle that can once again further worsens mental health. The study goes on to mention that obsessive thinking, rumination regarding guilt from the past, and anxiety resulted in higher pain in the last three months. Dr. Cristina Zarbo, Ph.D., the clinical psychologist leading the study, used these results to formulate an effective treatment method for women diagnosed with endometriosis. Dr. Zarbo believes the best way to tackle the mental health aspect of the disorder and thereby lessen pain would be to include a clinical psychologist in the team of medical professionals assessing the patient. That way, the psychologist can monitor the patient’s mental state throughout treatment, provide efficient coping strategies for the patient, and help them adopt a more positive and healthier working mindset.

If you are experiencing any symptoms associated with endometriosis or believe your mental health is a prominent factor towards the pain you’re experiencing, please consult your OBGYN. El Camino Women’s Medical Group provides comprehensive evaluation and treatment of endometriosis, as well as Minimally Invasive Solutions when surgery is needed.

El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems.   Drs. Amy TengErika Balassiano, and Pooja Gupta, all members of AAGL (American Association of Gynecologic Laparoscopy) are highly trained and experienced in the field of Minimally Invasive Gynecologic Surgery.   Dr. Erika Balassiano has also completed a Minimally Invasive Gynecologic Surgery Fellowship, under the supervision of world-renowned Dr. Camran Nezhat.


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