Endometriosis Beyond the Body: A Review of Its Impact on Mental Health, Sexual Function, and Fertility
DOI:
https://doi.org/10.12775/QS.2026.57.72473Keywords
endometriosis, quality of life, infertility, Mental health, SexualityAbstract
Introduction:
Endometriosis is a chronic, hormone-dependent condition affecting up to 15% of women of reproductive age. It is associated with pain, infertility, and a significant reduction in quality of life. Despite increasing awareness, the average diagnostic delay remains between 7 and 11 years. The disease is characterized by chronic pelvic pain, fatigue, dyspareunia, and emotional distress, which may contribute to depression, anxiety, decreased self-esteem, and social isolation. Sexual dysfunction arises from both physical symptoms and psychological factors. Endometriosis is also recognized as a leading cause of infertility.
Objective:
The aim of this review is to evaluate the impact of endometriosis on women’s mental health, sexual functioning, and fertility, with particular emphasis on diagnostic delays and social stigma.
Methods and materials:
A literature review was conducted using publications available in the PubMed and Google Scholar databases from 2017-2025. The most relevant and recent studies were selected using appropriate keywords.
Conclusions:
Endometriosis requires a holistic and multidisciplinary approach that integrates medical management with psychological and sexual health support. Addressing mental health and social well-being is essential for improving overall quality of life in affected women. Early diagnosis and the reduction of stigma remain key challenges in contemporary clinical practice.
References
1. Ruszała M, Dłuski DF, Winkler I, Kotarski J, Rechberger T, Gogacz M. The State of
Health and the Quality of Life in Women Suffering from Endometriosis. J Clin Med.
2022 Apr 6;11(7):2059. doi: 10.3390/jcm11072059. PMID: 35407668; PMCID:
PMC8999939.
2. Laganà AS, La Rosa VL, Rapisarda AMC, Valenti G, Sapia F, Chiofalo B, Rossetti D,
Ban Frangež H, Vrtačnik Bokal E, Vitale SG. Anxiety and depression in patients with
endometriosis: impact and management challenges. Int J Womens Health. 2017 May
16;9:323-330. doi: 10.2147/IJWH.S119729. PMID: 28553145; PMCID:
PMC5440042.
3. Della Corte L, Di Filippo C, Gabrielli O, Reppuccia S, La Rosa VL, Ragusa R,
Fichera M, Commodari E, Bifulco G, Giampaolino P. The Burden of Endometriosis
on Women's Lifespan: A Narrative Overview on Quality of Life and Psychosocial
Wellbeing. Int J Environ Res Public Health. 2020 Jun 29;17(13):4683. doi:
10.3390/ijerph17134683. PMID: 32610665; PMCID: PMC7370081.
4. Maulenkul, T., Kuandyk, A., Makhadiyeva, D. et al. Understanding the impact of
endometriosis on women’s life: an integrative review of systematic reviews. BMC
Women's Health 24, 524 (2024). https://doi.org/10.1186/s12905-024-03369-5
5. Márki G, Bokor A, Rigó J, Rigó A. Physical pain and emotion regulation as the main
predictive factors of health-related quality of life in women living with endometriosis.
Hum Reprod. 2017 Jul 1;32(7):1432-1438. doi: 10.1093/humrep/dex091. PMID:
28482063.
6. Facchin F, Barbara G, Dridi D, Alberico D, Buggio L, Somigliana E, Saita E,
Vercellini P. Mental health in women with endometriosis: searching for predictors of
psychological distress. Hum Reprod. 2017 Sep 1;32(9):1855-1861. doi:
10.1093/humrep/dex249. PMID: 28854724.
7. Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of
life and work productivity: a multicenter study across ten countries. Fertil Steril.
2011;96(2):366-373.
8. De Corte P, Klinghardt M, von Stockum S, Heinemann K. Time to Diagnose
Endometriosis: Current Status, Challenges and Regional Characteristics-A Systematic
Literature Review. BJOG. 2025 Jan;132(2):118-130. doi: 10.1111/1471-0528.17973.
Epub 2024 Oct 7. Erratum in: BJOG. 2025 Jun;132(7):1018. doi:
10.1111/1471-0528.18149. PMID: 39373298; PMCID: PMC11625652.
9. Grigoriadis G, Roman H, Kalaitzopoulos DR, Christoforidis N, Pados G, Daniilidis
A. Diagnosis of Endometriosis by Transvaginal Ultrasound: An Online Survey of
Gynecologists Practising in Greece. Cureus. 2023 Apr 21;15(4):e37950. doi:
10.7759/cureus.37950. PMID: 37220449; PMCID: PMC10200312.
10. Sims OT, Gupta J, Missmer SA, Aninye IO. Stigma and Endometriosis: A Brief
Overview and Recommendations to Improve Psychosocial Well-Being and Diagnostic
Delay. Int J Environ Res Public Health. 2021 Aug 3;18(15):8210. doi:
10.3390/ijerph18158210. PMID: 34360501; PMCID: PMC8346066.
11. Fryer J, Mason-Jones AJ, Woodward A. Understanding diagnostic delay for
endometriosis: A scoping review using the social-ecological framework. Health Care
Women Int. 2025;46(3):335-351. doi: 10.1080/07399332.2024.2413056. Epub 2024
Oct 17. PMID: 39418593.
12. Ozkan S, Murk W, Arici A. Endometriosis and infertility: epidemiology and
evidence-based treatments. Ann N Y Acad Sci. 2008 Apr;1127:92-100. doi:
10.1196/annals.1434.007. PMID: 18443335.
13. Filip L, Duică F, Prădatu A, Crețoiu D, Suciu N, Crețoiu SM, Predescu DV , Varlas
VN, V oinea SC. Endometriosis Associated Infertility: A Critical Review and Analysis
on Etiopathogenesis and Therapeutic Approaches. Medicina (Kaunas). 2020 Sep
9;56(9):460. doi: 10.3390/medicina56090460. PMID: 32916976; PMCID:
PMC7559069.
14. Broi MGD, Ferriani RA, Navarro PA. Ethiopathogenic mechanisms of
endometriosis-related infertility. JBRA Assist Reprod. 2019 Aug 22;23(3):273-280.
doi: 10.5935/1518-0557.20190029. PMID: 31091056; PMCID: PMC6724396.
15. Kutlesic R, Kutlesic M, Milosevic-Stevanovic J, Vukomanovic P, Stefanovic M,
Mostic-Stanisic D. Prolactin and Hyperprolactinaemia in Endometriosis-Related
Infertility: Are There Clinically Significant Connections? Journal of Clinical
Medicine. 2024; 13(19):5868. https://doi.org/10.3390/jcm13195868
16. Esmaeilzadeh S, Mirabi P, Basirat Z, Zeinalzadeh M, Khafri S. Association between
endometriosis and hyperprolactinemia in infertile women. Iran J Reprod Med. 2015
Mar;13(3):155-60. PMID: 26000006; PMCID: PMC4426155.
17. Frontiers | Update on the pathogenesis of endometriosis-related infertility based on
contemporary evidence. Front Endocrinol (Lausanne). 2025;16:1558271.
doi:10.3389/fendo.2025.1558271.
18. Dmowski WP, Rao R, Scommegna A. The luteinized unruptured follicle syndrome
and endometriosis. Fertil Steril. 1980 Jan;33(1):30-4. doi:
10.1016/s0015-0282(16)44473-0. PMID: 7351255.
19. Bonavina G, Taylor HS. Endometriosis-associated infertility: From pathophysiology
to tailored treatment. Front Endocrinol (Lausanne). 2022 Oct 26;13:1020827. doi:
10.3389/fendo.2022.1020827. PMID: 36387918; PMCID: PMC9643365.
20. van Poll M, van Barneveld E, Aerts L, et al. Endometriosis and Sexual Quality of
Life. Sex Med. 2020;8(4):532–44. doi:10.1016/j.esxm.2020.05.001.
21. Wang Y , Li B, Zhou Y , Wang Y , Han X, Zhang S, He Z, Ouyang L. Does
Endometriosis Disturb Mental Health and Quality of Life? A Systematic Review and
Meta-Analysis. Gynecol Obstet Invest. 2021;86(4):315-335. doi: 10.1159/000516517.
Epub 2021 Aug 5. PMID: 34352799.
22. Barbara G, Facchin F, Meschia M, Berlanda N, Frattaruolo MP, VercellinI P. When
love hurts. A systematic review on the effects of surgical and pharmacological
treatments for endometriosis on female sexual functioning. Acta Obstet Gynecol
Scand. 2017 Jun;96(6):668-687. doi: 10.1111/aogs.13031. Epub 2016 Nov 5. PMID:
27687240.
23. Pereira MG, Ribeiro I, Ferreira H, Osório F, Nogueira-Silva C, Almeida AC.
Psychological Morbidity in Endometriosis: A Couple's Study. Int J Environ Res
Public Health. 2021 Oct 10;18(20):10598. doi: 10.3390/ijerph182010598. PMID:
34682344; PMCID: PMC8535360.
24. Machairiotis N, Genazzani A. Endometriosis: A Comprehensive Analysis of the
Pathophysiology, Treatment, and Nutritional Aspects, and Its Repercussions on the
Quality of Life of Patients. Biomedicines. 2024;12(7):1476.
doi:10.3390/biomedicines12071476.
25. Wang Y , Nicholes K, Shih IM. The Origin and Pathogenesis of Endometriosis. Annu
Rev Pathol. 2020 Jan 24;15:71-95. doi:
10.1146/annurev-pathmechdis-012419-032654. Epub 2019 Sep 3. PMID: 31479615;
PMCID: PMC7980953.
26. Gruber TM, Mechsner S. Pathogenesis of Endometriosis: The Origin of Pain and
Subfertility. Cells. 2021 Jun 3;10(6):1381. doi: 10.3390/cells10061381. PMID:
34205040; PMCID: PMC8226491.
27. Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010 Jun
24;362(25):2389-98. doi: 10.1056/NEJMcp1000274. PMID: 20573927; PMCID:
PMC3108065.
28. Practice Committee of the American Society for Reproductive Medicine.
Endometriosis and infertility: a committee opinion. Fertil Steril. 2012
Sep;98(3):591-8. doi: 10.1016/j.fertnstert.2012.05.031. Epub 2012 Jun 15. PMID:
22704630.
29. Omtvedt M, Bean E, Hald K, Larby ER, Majak GB, Tellum T. Patients' and relatives'
perspectives on best possible care in the context of developing a multidisciplinary
center for endometriosis and adenomyosis: findings from a national survey. BMC
Womens Health. 2022 Jun 10;22(1):219. doi: 10.1186/s12905-022-01798-8. PMID:
35689259; PMCID: PMC9188072.
30. Lorençatto C, Petta CA, Navarro MJ, Bahamondes L, Matos A. Depression in women
with endometriosis with and without chronic pelvic pain. Acta Obstet Gynecol Scand.
2006;85(1):88-92. doi: 10.1080/00016340500456118. PMID: 16521687.
31. Fourquet J, Gao X, Zavala D, Orengo JC, Abac S, Ruiz A, Laboy J, Flores I. Patients'
report on how endometriosis affects health, work, and daily life. Fertil Steril. 2010
May 1;93(7):2424-8. doi: 10.1016/j.fertnstert.2009.09.017. PMID: 19926084;
PMCID: PMC2860000.
32. Rempert AN, Rempert TH, Liu A, Hernández A, Blanck J, Segars J, Singh B. A
Systematic Review of the Psychosocial Impact of Endometriosis before and after
Treatment. Reprod Sci. 2024 Jul;31(7):1828-1860. doi:
10.1007/s43032-024-01515-w. Epub 2024 Mar 21. PMID: 38512699; PMCID:
PMC11216884.
33. Ramin-Wright A, Schwartz ASK, Geraedts K, Rauchfuss M, Wölfler MM, Haeberlin
F, von Orelli S, Eberhard M, Imthurn B, Imesch P, Fink D, Leeners B. Fatigue - a
symptom in endometriosis. Hum Reprod. 2018 Aug 1;33(8):1459-1465. doi:
10.1093/humrep/dey115. PMID: 29947766.
34. Vaghar MI. Evaluation of lifestyle and endometriosis in infertile women referring to
the selected hospital of Tehran University Medical Sciences. J Family Med Prim Care.
2019 Nov 15;8(11):3574-3577. doi: 10.4103/jfmpc.jfmpc_496_19. PMID: 31803655;
PMCID: PMC6881964.
35. Lee J, Park HJ, Yi KW. Dienogest in endometriosis treatment: A narrative literature
review. Clin Exp Reprod Med. 2023 Dec;50(4):223-229. doi:
10.5653/cerm.2023.06128. Epub 2023 Oct 24. PMID: 37995750; PMCID:
PMC10711247.
36. Bafort C, Beebeejaun Y , Tomassetti C, Bosteels J, Duffy JM. Laparoscopic surgery
for endometriosis. Cochrane Database Syst Rev. 2020 Oct 23;10(10):CD011031. doi:
10.1002/14651858.CD011031.pub3. PMID: 33095458; PMCID: PMC8428328.
37. Barbara G, Buggio L, Facchin F, Vercellini P. Medical Treatment for Endometriosis:
Tolerability, Quality of Life and Adherence. Front Glob Womens Health. 2021 Sep
27;2:729601. doi: 10.3389/fgwh.2021.729601. PMID: 34816243; PMCID:
PMC8594049.
38. Kaveh M, Malakouti H, Chaichian S, Kashi AM, Afshari M, Sadegi K. Evaluation of
laparoscopic surgery effects on pain severity and quality of life in different subtypes
of endometriosis: A follow-up study. Int J Reprod Biomed. 2025 May
1;23(2):199-206. doi: 10.18502/ijrm.v23i2.18494. PMID: 40371363; PMCID:
PMC12070047.
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Copyright (c) 2026 Gabriela Babiarz, Damian Osiński, Zuzanna Kawa, Maria Kasprzak, Aleksandra Jędrzejewska, Aleksandra Jureczko, Klaudia Kleczaj, Łukasz Starczewski, Julia Jaworowska, Julia Kanarszczuk

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