Does Stress Make Endometriosis Worse and Fibroids: What to Know

Does Stress Make Endometriosis and Fibroids Worse? What to Know

Endometriosis and uterine fibroids are two of the most common gynecologic conditions, affecting millions of people worldwide. Many patients notice that their pelvic pain, heavy bleeding, or fatigue seem worse during stressful periods—and wonder whether stress actually worsens these conditions. Here’s what research and expert sources suggest, plus practical ways to manage stress alongside medical care.

Quick refresher: What are endometriosis and fibroids?

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, often causing pain, inflammation, and sometimes infertility. It is a chronic condition with variable symptoms, including painful periods, pelvic pain, pain with sex, and bowel or bladder discomfort. Learn more from the National Institutes of Health (NIH) and MedlinePlus: MedlinePlus: Endometriosis.

Uterine fibroids are noncancerous growths of the uterine muscle that can cause heavy menstrual bleeding, pelvic pressure, urinary frequency, and pain, though many are asymptomatic. See: MedlinePlus: Uterine Fibroids.

How stress affects the body—and why symptoms may flare

Stress activates the body’s stress response, including the hypothalamic–pituitary–adrenal (HPA) axis and sympathetic nervous system. Over time, chronic stress can influence inflammation, pain perception, sleep quality, and mood. These pathways don’t “cause” endometriosis or fibroids, but they can shape how intensely you perceive symptoms and how well you cope day to day. The National Institute of Mental Health explains stress and its health effects here: NIMH: Stress.

In chronic pain conditions, stress can amplify pain signals and lower pain thresholds, making existing pelvic pain feel worse. Mind and body approaches (such as mindfulness and cognitive behavioral strategies) have shown benefits for chronic pain and stress management in NIH reviews: NCCIH: Mind and Body Approaches for Pain.

Endometriosis and stress: What the evidence says

Endometriosis is driven by complex hormonal, immune, and inflammatory mechanisms. Current evidence does not show that stress causes endometriosis. However:

  • People with endometriosis often report more pain and reduced quality of life during periods of higher stress.
  • Stress may influence inflammatory and pain-processing pathways, potentially intensifying symptoms such as dysmenorrhea and pelvic pain.
  • Sleep disruption and mood changes linked to stress can further sensitize the nervous system, creating a feedback loop of pain and distress.

Bottom line: While stress isn’t the root cause, it can be a powerful symptom amplifier in endometriosis. Treating the underlying condition and managing stress together typically yields the best results. See NIH resources on endometriosis: NICHD: Endometriosis and MedlinePlus.

Fibroids and stress: Is there a link?

Fibroid growth is primarily influenced by estrogen and progesterone, along with genetic and environmental factors. There’s no definitive evidence that stress causes fibroids. Some observational research suggests that psychosocial stress might be associated with symptom burden (for example, perceived heaviness of bleeding or pain), but data are mixed and more research is needed.

Practically speaking, stress can affect how you experience symptoms, how consistently you follow treatment plans, and how fatigued you feel. Addressing stress won’t shrink fibroids, but it can help you cope better and improve overall well-being. For core information on fibroids, see: MedlinePlus: Uterine Fibroids.

What actually helps: Stress management that supports symptom control

Adding evidence-informed stress strategies to medical care can reduce symptom flares and improve quality of life:

  • Mindfulness, relaxation, and CBT skills. Mindfulness-based stress reduction, diaphragmatic breathing, and cognitive behavioral strategies can lower pain intensity and stress. Evidence summaries: NCCIH.
  • Regular physical activity. Even 150 minutes per week of moderate activity (e.g., brisk walking) can ease stress, improve sleep, and support mood. See CDC activity guidelines. Choose low-impact options during flares.
  • Sleep hygiene. Consistent sleep schedules, light management, and wind-down routines help regulate stress hormones and pain perception. See NHLBI: Sleep and Health.
  • Pelvic floor physical therapy. For pelvic pain and muscle tension, a pelvic floor therapist can teach relaxation, stretching, and pain-modulating techniques.
  • Social support and counseling. Support groups, therapy, and patient education reduce isolation and enhance coping.

Medical treatments remain the foundation

Stress management is an adjunct, not a replacement, for medical care. Discuss options with your clinician to tailor treatment to your goals (pain control, bleeding reduction, fertility, or organ-preserving approaches).

Endometriosis: Evidence-based options

  • Anti-inflammatory pain relief: NSAIDs may help with menstrual pain.
  • Hormonal suppression: Combined hormonal contraceptives, progestins, and levonorgestrel IUDs can reduce pain by suppressing menstruation.
  • GnRH therapies: GnRH agonists (e.g., leuprolide) and antagonists (e.g., elagolix; relugolix/estradiol/norethindrone acetate) are FDA-approved options for moderate to severe endometriosis pain and can be used with add-back therapy to mitigate side effects. See FDA information on approvals (e.g., FDA: Endometriosis Pain Treatment Approval).
  • Surgery: Laparoscopic excision/ablation can relieve pain and address lesions; shared decision-making is key, especially if fertility is a goal.

Fibroids: Evidence-based options

  • Watchful waiting for small or asymptomatic fibroids.
  • Bleeding control: NSAIDs, hormonal contraception, levonorgestrel IUD, and tranexamic acid (an FDA-approved nonhormonal option for heavy menstrual bleeding).
  • GnRH antagonists with add-back: Oral combinations such as elagolix/estradiol/norethindrone acetate (brand Oriahnn) and relugolix/estradiol/norethindrone acetate (brand Myfembree) are FDA-approved to reduce heavy menstrual bleeding due to fibroids. See FDA announcements: Oriahnn approval and Myfembree approval.
  • Procedures: Uterine artery embolization, radiofrequency ablation, MRI-guided focused ultrasound, myomectomy (uterus-sparing), or hysterectomy (definitive) depending on symptoms, size/location, and fertility goals.

When to seek care—and how to talk with your clinician

Get medical advice promptly if you have heavy bleeding that soaks through pads or tampons hourly, severe or worsening pelvic pain, symptoms of anemia (fatigue, shortness of breath, dizziness), or if symptoms disrupt work, school, or daily life. Track cycles, pain levels, bleeding, and stressors in a symptom journal—these details help your clinician tailor care.

The takeaway

Stress doesn’t cause endometriosis or fibroids, but it can heighten pain, fatigue, and perceived symptom burden. Combining condition-specific medical treatment with proven stress-management strategies—mindfulness or CBT skills, movement, restorative sleep, and social support—can make a meaningful difference.

Trusted resources

This article is for educational purposes and does not replace personalized medical advice. Always consult your clinician about diagnosis and treatment decisions.

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