Endometriosis and your mental health
Endometriosis pain is real, and so is the toll it can take on your mind. You deserve care for both.
By the numbers
How common endometriosis is, and how it touches mood.
Endometriosis
Mood
Endometriosis in plain words
A long-term condition that can affect your whole life.
Endometriosis is when tissue similar to the lining of the uterus grows outside it. It can cause pain, inflammation and scarring. There is no cure yet, but care aims to control symptoms.
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- Bloating, nausea or bowel and bladder pain
- Deep pain during or after sex
- Ongoing pelvic and lower back pain
- Severe period pain that may get worse over time
- Trouble getting pregnant
Some people have no symptoms at all.
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The NHS lists extreme tiredness, low mood and anxiety as possible effects. It says symptoms can affect daily life, work and relationships for many years.
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It can affect any girl or woman with periods and is especially common in the 30s and 40s. It can also affect trans men and nonbinary people. The Endometriosis Foundation of America has an LGBTQIA resource hub.
How pain and mood feed each other
Ongoing pain is the biggest driver of low mood.
A review of 24 studies found that women with endometriosis had higher levels of depression. The authors say the link is largely driven by ongoing pain. Women with endometriosis and pelvic pain had much higher depression levels than those without pain.
A 2023 review also found a strong link between endometriosis pain and depression and anxiety. Tiredness and poor sleep were linked with lower mood too.
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Pain disturbs sleep and stops you doing things you enjoy. That can lower mood and raise worry, which can make pain harder to cope with.
The good news is that care for one side can help the other. That is why pain care teams often include therapy.
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Some people with endometriosis have been told their symptoms were psychological. Research shows the mood link is largely about living with real, ongoing pain.
The years before a diagnosis
Being told “it’s just periods” can leave deep marks.
The WHO says many people, including most health workers in many countries, do not realise that ongoing pelvic pain is not normal. This normalising of pain harms mental health and wellbeing.
In a study across 10 countries, the average delay from first symptoms to diagnosis was almost 7 years, mostly in primary care.
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A review of 14 studies found women often felt their pain was doubted or treated as normal period pain. Some were told to learn to cope.
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Many women felt relief at a diagnosis because it was proof the pain was real. It is also normal to feel grief or anger about lost years.
Writing your story down, or talking it through with a therapist, can help you make peace with it.
Flares, tiredness and uncertainty
Not knowing how tomorrow will feel is hard.
Endometriosis is a long-term condition, and symptoms can come and go. Severe pain, tiredness and isolation can greatly reduce quality of life.
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- Have a “flare kit” ready: heat pack, comfy clothes, snacks
- Keep a pain and period diary to spot patterns
- Plan rest before and after big days
- Tell one person how to help when a flare starts
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Break big tasks into smaller pieces and rest before you are exhausted. Pacing helps you keep doing what matters without crashing.
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Missed events, changed plans and lost energy are real losses. Naming them can make room for new ways to live well.
Therapy and team-based pain care
Physical therapy and CBT can reduce pain and lift quality of life.
The WHO says team-based pain care, including physiotherapy and cognitive behavioural therapy (CBT), can reduce pain and improve quality of life. These address both the physical and emotional load.
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CBT helps you notice thoughts like “this will never get better” and find more balanced ones. You also learn pacing, relaxation and problem-solving skills.
It does not mean your pain is imagined. It is a tool to help you live with real pain.
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Physiotherapy is part of the team approach the WHO describes. Ask your provider whether a pelvic health physical therapist could help you.
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- Can I see a therapist who understands chronic pain?
- Is pelvic physical therapy right for me?
- What are my treatment options, and what are the trade-offs?
- Who can help with my sleep and tiredness?
Fertility worries and the future
Living with uncertainty about having children.
Endometriosis is linked with infertility. The WHO says between 25% and 50% of women with infertility have it. Many women with endometriosis do get pregnant.
A review found planning for and having children was one of the main ways endometriosis affects women’s lives. Another suggests that infertility together with childlessness may weigh on mental health.
Everyday ways to look after your mind
Small habits that make hard days a little easier.
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Women in research describe heat, such as a hot water bottle, and warm showers as helpful for pain.
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Stretching, walking or gentle yoga can lift mood. Listen to your body and rest when you need to.
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A review linked poor sleep and tiredness with depression in endometriosis. A calm wind-down routine and steady wake time can help.
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The WHO names social isolation as one of the things that lowers quality of life. Even a short message or a video call on a bad day can help.
Finding people who understand
Support groups offer advice and emotional support.
The WHO says local patient support groups can offer advice and emotional support. Hearing from others who “get it” can ease loneliness and shame.
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EndoFound shares patient information, personal stories, a guide to preparing for appointments, and resource hubs for people of colour and LGBTQIA people. Website: endofound.org.
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- Ask what a bad day looks like and how you can help
- Don’t say “periods hurt for everyone”
- Help with chores on high-pain days
- Offer to come to appointments
When and where to get help
Signs it is time to reach out, and where to go.
Reach out if…
- Low mood or worry lasts most days for two weeks or more
- Pain stops you working, studying or sleeping
- You feel hopeless or are pulling away from people
- You have thoughts of harming yourself
Good places to start are your primary care provider, gynaecologist or a pain clinic. Ask for a referral to a therapist who understands chronic pain.
Outside the U.S.: Find A Helpline (findahelpline.com) lists free, confidential helplines in many countries. In the UK, Endometriosis UK runs support groups, an online community and helplines.
📝 Worksheets for this guide
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Sources
- World Health Organization (WHO). Endometriosis fact sheet
- Office on Women’s Health (womenshealth.gov). Endometriosis
- NHS (UK National Health Service). Endometriosis
- Gambadauro P., Carli V. & Hadlaczky G. (peer-reviewed) (2019). Depressive symptoms among women with endometriosis: a systematic review and meta-analysis (American Journal of Obstetrics & Gynecology 220(3): 230–241)
- Szypłowska M., Tarkowski R. & Kułak K. (peer-reviewed) (2023). The impact of endometriosis on depressive and anxiety symptoms and quality of life: a systematic review (Frontiers in Public Health 11: 1230303)
- Nnoaham K.E. et al. (peer-reviewed) (2011). Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries (Fertility and Sterility 96(2): 366–373)
- Pettersson A. & Berterö C.M. (peer-reviewed) (2020). How Women with Endometriosis Experience Health Care Encounters (Women’s Health Reports 1(1): 529–542)
- Culley L. et al. (peer-reviewed) (2013). The social and psychological impact of endometriosis on women’s lives: a critical narrative review (Human Reproduction Update 19(6): 625–639)
- Facchin F. et al. (peer-reviewed) (2021). The Subjective Experience of Dyspareunia in Women with Endometriosis: A Systematic Review with Narrative Synthesis of Qualitative Research (Int. J. Environ. Res. Public Health 18(22): 12112)
- Endometriosis Foundation of America (EndoFound). Endometriosis Foundation of America
- Endometriosis UK (charity). Endometriosis UK
- National Institute of Mental Health (NIMH). Depression in Women: 4 Things to Know
- Find A Helpline (ThroughLine). Find A Helpline
This guide is for education and self-care. It is not a diagnosis or a substitute for professional care. Please talk to a counselor or clinical provider about your health. Reviewed October 2026.
