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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 per cent-15 per cent 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 per cent) and sexual trauma (5 per cent) compared to women without the disease (5 per cent and 4

per cent, respectively). Women without endometriosis were more likely to be placed in the group with no trauma (24 per cent) compared to those with the disease (20 per cent). 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. 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_, Postdoctoral Researcher in Women's Health, _Universitat de Barcelona_ and _Renato

Polimanti_, Associate Professor of Psychiatry, of Chronic Disease Epidemiology and of Biomedical Informatics and Data Science, _Yale University__ _This article is republished from__The

Conversation__under a Creative Commons license. Read the _original article_._