Endometriosis and Trauma: What the Research Now Tells Us

Three major studies have found that women with a history of childhood adversity or traumatic experiences are significantly more likely to be diagnosed with endometriosis.

Endometriosis is a chronic hormonal and inflammatory condition affecting approximately 10% of women of reproductive age, in which tissue similar to the uterine lining grows outside the uterus. Its causes are not fully understood, and diagnosis is often delayed by years, in the UK that can mean up to 10 years. A growing body of research now suggests that traumatic experiences, in both childhood and adulthood, are meaningfully associated with the risk of developing the condition, and that the relationship between trauma and hormonal health is more biologically significant than previously recognised.

What the latest research found

Three studies published in 2025 add considerable weight to what was already emerging evidence.

A nationwide cohort study from the Karolinska Institutet, published in Human Reproduction in June 2025, followed over 1.3 million women born in Sweden between 1974 and 2001. Researchers examined register-based data on adverse childhood experiences (ACEs), including parental substance abuse, exposure to violence, residential instability, parental separation and child welfare intervention, and tracked subsequent endometriosis diagnoses over decades. All of the adverse childhood experiences examined, except the death of a family member, were associated with an increased risk of later endometriosis diagnosis. Women who had experienced any single adversity had a 20% higher risk compared to those with none. Those with five or more adversities had a 60% higher risk. The strongest individual association was with direct exposure to violence in childhood, which was linked to almost double the risk of endometriosis diagnosis after adjustment for other variables.

A case-control study published in JAMA Psychiatry in February 2025 examined up to 8,276 women with endometriosis and over 240,000 female controls enrolled in the UK Biobank. Women with endometriosis were more likely to report traumatic experiences across both childhood and adulthood, with the strongest association observed for contact trauma, meaning trauma involving direct physical harm. In a multivariable model that also accounted for genetic predisposition, contact trauma remained independently associated with endometriosis. The genetic analyses found a meaningful shared genetic architecture between endometriosis and post-traumatic stress disorder (PTSD), with a genetic correlation of 0.31, described by the authors as among the most significant findings of the study. This suggests that part of the relationship between trauma and endometriosis may be rooted in shared biological pathways, rather than one straightforwardly causing the other.

A letter published in Annals of Medicine and Surgery in late 2025 by Irshad and colleagues reviewed this emerging evidence and concluded that trauma history should be formally assessed in the context of endometriosis care, with coordinated input from gynaecologists, mental health professionals and primary care providers.

Why trauma may affect hormonal and immune health

The biological mechanisms linking trauma to endometriosis are not yet fully established, and researchers have proposed several plausible pathways. One involves immune dysregulation. Endometriosis is understood to involve a dysfunctional immune response that allows endometrial-like tissue to implant and survive outside the uterus. Childhood adversity has been associated with chronic systemic inflammation and altered immune markers, a pattern consistent with what is observed in endometriosis.

A second pathway involves the hypothalamic-pituitary-adrenal (HPA) axis, the body's central stress response system. Childhood trauma has been linked to persistent dysregulation of this axis, and women with endometriosis have been found to show altered cortisol patterns, suggesting overlap in how the body processes stress at a hormonal level.

A third possibility is that trauma increases pain sensitisation, meaning changes in how the central nervous system processes pain signals, which may raise the likelihood of seeking medical attention for gynaecological symptoms such as pelvic pain and dysmenorrhoea. Some researchers caution that this could partly explain higher diagnosed rates of endometriosis in women with ACEs: not only because the condition may develop more readily, but because pain sensitisation increases the probability of a diagnosis being made.

These mechanisms are not mutually exclusive. It is likely that multiple pathways are involved for different women.

What this means in clinical practice

The Karolinska study authors are direct in their conclusion: clinicians should be aware of childhood adversity as a potential risk factor when assessing women who present with pelvic pain or dysmenorrhoea. A thorough gynaecological evaluation is warranted in women who have experienced childhood adversity and present with these symptoms, many of whom currently wait years for a diagnosis.

The JAMA Psychiatry findings add another dimension. The shared genetic architecture between endometriosis and PTSD does not mean that trauma causes endometriosis in a straightforward sense; the relationship is more complex. It does suggest that endometriosis screening programmes may be strengthened by incorporating assessments of contact trauma and genetic predisposition alongside clinical symptoms.

There are important caveats to note. Both large studies relied primarily on populations of European descent, and the Swedish cohort used secondary-care diagnoses, meaning milder or undetected cases may not have been captured. Endometriosis remains significantly underdiagnosed, which means associations observed in registered diagnosis data may actually understate the true relationship with trauma.

The mental health dimension

Living with endometriosis is associated with elevated rates of anxiety and depression, and the bidirectional relationship between hormonal conditions and mental health is one of the clearest areas of emerging research in women's health. What the 2025 evidence adds is not simply that mental health difficulties and endometriosis co-occur, which has been established for some time, but that trauma may be part of the biological substrate connecting them. The genetic overlap with PTSD, the disruption to the HPA axis and the pattern of chronic inflammation are not separate conversations about mind and body. They describe a single, interconnected biological system in which the effects of early adversity can influence hormonal and immune function for years.

For women living with endometriosis who also carry a history of trauma, this research does not assign blame or offer a simple causal story. It does make clear that the two are not unrelated, and that care for endometriosis will need to extend beyond surgical or hormonal intervention alone.

References

1. Rostvall M, Magnusson C, Gemzell-Danielsson K, Kosidou K, Sieurin J. Adverse childhood experiences and the risk of endometriosis: a nationwide cohort study. Human Reproduction. 2025;40(9):1735–1743.

2. Koller D, Løkhammer S, Goroshchuk O, et al. Observational and genetic analyses of traumatic experiences and endometriosis. JAMA Psychiatry. 2025;82(4):386–394.

3. Irshad N, Atif MM, et al. Linking childhood trauma to endometriosis: evidence and implications for reproductive health screening. Annals of Medicine and Surgery. 2025.

This article is for informational purposes only and is not a substitute for professional medical advice. If you have concerns about your health or are considering making any changes to your health regime, speak to a qualified healthcare professional first.