Relationship between endometriosis and mental health. A systematic review and meta-analysis

The chronic gynecological condition endometriosis affects about 10 percent of reproductive aged women and imposes a heavy physical and psychological burden. The impact of pain and infertility is well documented, but the link between endometriosis and mental health (depressive and anxiety), in particular, is not well studied. In this systematic review and meta-analysis, we synthesize evidence on the association between endometriosis and mental health outcomes, specifically anxiety and depression.Methods: PubMed, Cochrane Library and Google Scholar were searched comprehensively to identify studies that have reported the association of endometriosis and mental health outcomes. Nine studies were included after applying predefined inclusion and exclusion criteria from 1,632 articles screened. The Newcastle-Ottawa Scale (NOS) was used to assess study quality and random effects meta-analyses were performed using R. Relative risk (RR) values for anxiety and depression among women with endometriosis were pooled as the primary outcomes.

The meta-analysis revealed a significant association between endometriosis and anxiety (pooled RR = 2.82; 95% CI: 1.69-4.68, p < 0.001) and depression (pooled RR = 2.93; 95% CI: 1.63-5.25, p < 0.001). Substantial heterogeneity was observed in both analyses (I ² = 100%), reflecting variability in study designs and populations. Funnel plots showed moderate asymmetry, suggesting potential publication bias. Statistical heterogeneity was further quantified with τ² values of 0.6032 for anxiety and 0.794 for depression, indicating considerable between-study variability. These findings underscore the heightened mental health burden in women with endometriosis.

Endometriosis patients are more likely to develop anxiety and depressive symptoms due to pain and diagnostic evaluation and related psychosocial factors. This study stresses the importance of integrated care, which involves screening and treatment for mental health problems in addition to conventional medical care. Future work should aim to reduce heterogeneity and examine potential pathways through which these relationships exist in order to develop specific prevention strategies.