Free guide · chronic illness
Endometriosis and Mental Health: It Is Not Just About Coping With Pain
The assumption is that if endometriosis affects your mental health, it is because chronic pain is depressing. That is part of it and nowhere near all of it. The connection runs through inflammation, the gut-brain axis, hormonal signalling, and years of being told there was nothing wrong with you.
PDF · 11 pagesFree · no cost, everSumarie Engelbrecht
Sound familiar?
This is for you if
I am exhausted and anxious and everyone puts it down to the pain
It took years to be believed and I am still angry about it
I never know how I will feel from one week to the next
I am grieving a future I assumed I would have
I want to understand what is actually happening in my body
The mechanism is not only the pain
It would be reasonable to assume that mental health effects in endometriosis are downstream of chronic pain, and pain certainly contributes. But the research points to more direct routes as well. Endometriosis is an inflammatory condition, and systemic inflammation has well-established links to depression through effects on neurotransmitter metabolism.
There is also a substantial gut-brain dimension. Endometriosis is associated with disruptions to the gut microbiome, and the bidirectional communication between gut and brain is increasingly implicated in mood regulation. None of this makes the psychological effects less real — it makes them less a matter of attitude, which is a distinction many people with this condition have been waiting a long time for.
What years of not being believed does
Diagnostic delay in endometriosis is commonly measured in years, frequently seven or more. During that period most people are told, repeatedly and by professionals, that their pain is normal, exaggerated, or psychological.
The effect of that is not incidental. Being systematically disbelieved about your own body damages trust in your own perception and trust in medical care, and produces a form of anger that has nowhere to go. Many people arrive at diagnosis relieved and furious at once, and then find there is no acknowledged place to put the fury. The guide treats this as a legitimate part of the picture rather than a footnote.
The fertility dimension
For people whose endometriosis affects fertility, there is a grief that is rarely given standing — for a future that was assumed rather than planned, and that may still be uncertain rather than closed. Ambiguous loss of this kind is harder to process than a definite one, precisely because there is no point at which it can be mourned properly.
It also tends to be poorly supported socially. People offer optimism, which forecloses the grief, or advice, which misses it. The guide names it directly, because for a lot of readers it is the part carrying the most weight and the part they have never seen written down.
Common questions
Questions people ask
Rates of both are substantially elevated among people with endometriosis. The relationship appears to run through several routes — chronic pain, systemic inflammation, gut-brain effects, hormonal factors and the experience of prolonged diagnostic delay — rather than through pain alone.
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Read articleThe part of this that is not medical
Living with a chronic condition carries a psychological load that medical care is not set up to hold. Counselling is where that part gets attention — the first session is free.
This guide is for information and is not a substitute for individual counselling. Written by Sumarie Engelbrecht, HPCSA Registered Counsellor (PRC 0042480).