Endometriosis, Depression and Anxiety: The Link and Support

If you have endometriosis, your risk of depression and anxiety is higher. In pooled studies, people with endometriosis were almost 3 times as likely to have anxiety or depression as people without it, and pain is a big part of the reason.

Your low mood or worry is not "all in your head", and you can get help for it. This guide explains why the two are linked, the signs to watch for, what helps, and how to raise it with your doctor. It is general information. Your own doctor decides what is right for you.

If you are in crisis now: in the UK, call 999 or go to A&E if your life is at risk or you do not feel you can keep yourself safe. For urgent help that is not an emergency, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123. In the US, call or text 988, the Suicide & Crisis Lifeline, at any time.

How common depression and anxiety are with endometriosis

Pooled across 9 studies, the risk of both anxiety and depression was close to 3 times higher in people with endometriosis. Single studies give very different numbers for how many people are affected, from about 10% to almost 99% for depressive symptoms and about 12% to 88% for anxiety, because they measure in different ways and in different groups.

Why endometriosis affects your mood

Pain

Pain is the clearest link. Chronic pelvic pain, painful periods, pain during sex and painful bowel movements are all linked to more depression and anxiety, and to a lower quality of life. The worse the pain, the higher the depression and anxiety scores tend to be.

Pain and worry can also feed each other. You may fear the next flare, cancel plans, or avoid work and friends because you do not know how you will feel. Pulling away protects you in the short term, but avoiding friends and social activities is also a sign of depression.

The road to a diagnosis

Getting a diagnosis can mean many appointments and tests. The pain and the process of diagnosis, together with other stresses in life, help explain the higher risk of anxiety and depression. Being told your pain is "normal" or "just stress" adds to the strain. Our guide to medical gaslighting and endometriosis covers how to push back.

Hormone treatments

Some studies found higher rates of depression in people who had used GnRH agonists or the contraceptive pill. This does not mean these medicines will affect you. If your mood changes after you start or change a hormone treatment, tell your doctor. Do not stop a treatment without talking to them first.

Fertility worries

Endometriosis can make it harder to get pregnant. The research on infertility and mood is mixed: some studies link it to more depression and others do not.

Signs of depression to watch for

Signs of depression include:

• Low mood or sadness that does not go away
• Feeling hopeless and helpless
• No motivation or interest in things you used to enjoy
• Feeling guilty, tearful or irritable
• Finding it hard to make decisions
• Changes in sleep, appetite or weight
• Lack of energy
• Avoiding friends and social activities

Many of these overlap with endometriosis itself, such as poor sleep and tiredness. That is one more reason to tell your doctor how you feel, and not only how much pain you have. Our guide to endometriosis and insomnia has more on sleep.

What helps

Talk to your doctor

Tell your doctor or GP if low mood or worry does not go away, or if it gets in the way of work, sleep or time with people. Reviews of the research call for screening and treatment for mental health problems as part of endometriosis care. Good care treats the pain and your mood together.

Talking therapy

Cognitive behavioural therapy (CBT) is a talking therapy used for depression, anxiety and long-term pain. It does not make pain go away. It helps you change how you think about and respond to pain and low mood, so they have less control over your day. In England, you can refer yourself to NHS talking therapies for anxiety and depression without seeing a GP first.

Plan for flares

A plan can make the next flare less frightening. Keep what helps you in one place, and write down what helped last time. Our guide to endometriosis flare-ups has more ideas.

Gentle movement and support

If your pain allows, gentle exercise such as a slow walk or restorative yoga can help you feel more in control of your body. Talking to other people with endometriosis, in a support group or online, can also help you feel less alone.

Write down your mood with your symptoms

A record of your mood next to your pain shows patterns that are easy to miss. It changes "I feel down" into "My mood drops on days my pelvic pain is 7 out of 10 or higher." That gives your doctor a clearer picture.

Each day, note:

• Your mood (score it 0 to 10)
• Anxiety or worry, and what set it off
• Your pain score and where it hurts
• Sleep
• The day of your cycle
• Any new or changed medicine

Our guide to a pain diary doctors will read shows how to keep it short. Write your mood score in a notebook or a note on your phone, next to your pain score. The Endolog endometriosis tracker app lets you log your pain and other symptoms, so you can read them next to your mood notes.

Related articles

• 20 Symptoms of Endometriosis and What the Pain Feels Like
• Pain Diary for Your Doctor: What to Track and How to Share
• Medical Gaslighting and Endometriosis