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Author: Dora Koller, Postdoctoral Researcher in Women's Health, Universitat de Barcelona
Original article: https://theconversation.com/traumatic-experiences-and-genetics-may-increase-endometriosis-risk-a-new-study-finds-253284
Endometriosis is a chronic and systemic inflammatory disease where uterine endometrial-like tissue grows outside the uterus. The most common symptom is debilitating pelvic pain before and during menstruation, or during intercourse. It can also cause infertility and digestive issues such as painful bowel movements, among many other symptoms. Globally, it affects a staggering 10%-15% of female individuals of reproductive age: around 190 million people.
Despite its prevalence, researchers have not yet found a definitive cause for endometriosis. However, our research contributes to a growing body of evidence suggesting that mental health may contribute to an increased risk.
Our study, published in JAMA Psychiatry in February 2025, found that women with endometriosis reported traumatic experiences and stressful events, both in childhood and adulthood, at a higher rate than those without the disease.
We based our research on clinical and genetic information available from almost 250,000 female participants enrolled in the UK Biobank, which included over 8,000 patients with endometriosis. We combined this information with genetic data from the FinnGen Project and several other cohorts: a total of over 500,000 women, which included over 30,000 endometriosis cases.
Diffferent types of trauma
In the UK Biobank data, we found that endometriosis patients were more likely to report experiencing sexual assault as an adult, receiving a life-threatening diagnosis, or having witnessed sudden death. When we grouped the traumatic events into categories, we found that endometriosis was associated with an increased likelihood of experiencing contact trauma, childhood maltreatment, non-interpersonal trauma, and non-contact trauma.
Furthermore, our analysis found clear groupings based on patterns of traumatic experiences. A higher percentage of women with endometriosis were grouped into categories based on emotional/physical trauma (8%) and sexual trauma (5%) compared to women without the disease (5% and 4%, respectively).
Women without endometriosis were more likely to be placed in the group with no trauma (24%) compared to those with the disease (20%).
Endometriosis was also genetically linked to posttraumatic stress disorder and childhood maltreatment. Other traits related to trauma and the estimates observed were consistent across cohorts with different characteristics.
Interestingly, we found that traumatic events and genetic factors can contribute independently to the risk of developing endometriosis. This means that genetic risk factors and traumatic experiences affect the likelihood of developing the disease in distinct, potentially compounding ways.
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Trauma and physical health
A growing number of studies highlight the fact that endometriosis is systemic, meaning it is not confined to one area and affects biological systems outside the reproductive organs. Indeed, trauma is linked to a range of health conditions, including cancer and heart disease.
While few studies to date have reported associations between traumatic events and endometriosis, some research has been done into the different trauma types and biological mechanisms that underpin the relationship.
Several dynamics could explain the association between trauma and endometriosis. For instance, stress responses to traumatic experiences can trigger inflammation in the body, which then contributes to developing endometriosis.
Trauma can also disrupt hormonal balance, especially by increasing stress hormones like cortisol. These hormonal changes might worsen endometriosis symptoms or influence its development by affecting oestrogen levels.
Trauma may also have long-term effects on epigenetics, influencing immune responses, inflammation, and hormonal regulation, all of which could contribute to the development or worsening of endometriosis.
Trauma-informed care
The interplay between trauma and endometriosis highlights the importance of assessing both physical and mental health of affected patients. This can help provide more comprehensive and effective treatment.
Trauma-informed care is a healthcare approach that supports and recognises the impact traumatic events have on people. It focuses on creating an environment of safety, trust, and empowerment for people who have experienced trauma, understanding that past trauma may affect how they interact with services or respond to care.
Trauma-informed care is particularly important in gynaecology, where examinations often involve sensitive areas of the body. For individuals who have experienced trauma, especially sexual or physical trauma, the gynaecological exam can be a potentially re-traumatising experience that discourages them from seeking care in the future.
This can even delay diagnosis and treatment further, which is already a lengthy process for patients with endometriosis. They often face a delay of 4 to 11 years before receiving proper care.
Our study expands the evidence supporting the important role of mental health in the systemic nature of endometriosis. In particular, our efforts to dissect the impact of traumatic events opens new paths to understanding how psychiatric risk factors can lead to negative clinical outcomes in women.
Dora Koller is the CEO of EndoCare Therapeutics.
Renato Polimanti acknowledges support from the National Institute of Mental Health