A Systematic Review of the Association Between Psychiatric Disturbances and Endometriosis

OBJECTIVE: An association between endometriosis and psychiatric disturbances has been identified by some researchers. The purpose of this systematic review was to consolidate existing empirical findings to clarify the association between endometriosis and psychiatric conditions. DATA SOURCES: We searched three electronic databases (Medline/PubMed, PsychInfo, and ClinicalTrials.gov) using the following search items: "endometriosis" combined with "mood," "bipolar disorder," "major depressive disorder," "anxiety," "psychiatric," "psychosocial," "antidepressants," "antianxiety," "pharmacotherapy," or "psychotherapy." STUDY SELECTION: We included all relevant articles published in English. We identified 18 original research studies examining the association between endometriosis and psychiatric symptoms, with a combined total of 999 endometriosis patients being examined. DATA EXTRACTION AND SYNTHESIS: Of the 18 studies examined, 14 reported that endometriosis was associated with at least some aspect of reduced psychological functioning or mental health quality of life. Tabulation of raw frequencies of the studies using clinical diagnostic criteria and a comparison group revealed that at least 56.4% of women (44/78) with a diagnosis of endometriosis and 43.6% of women (48/110) without such a diagnosis met the criteria for a psychiatric disorder. CONCLUSION: The limited research suggests that women presenting with endometriosis are at risk for psychosocial disturbances or psychiatric distress. Whether such disruptions are a consequence of endometriosis, the associated chronic gynaecological pain, or another factor such as inflammation remains to be delineated. In the interim, women presenting with symptoms of endometriosis should also be screened for psychosocial and psychiatric disturbances.