Endometriosis Mood Swings and Fibroids: What to Know

Mood swings are among the most frustrating symptoms people report when living with endometriosis or uterine fibroids. While these conditions primarily affect the reproductive system, their impact reaches far beyond pelvic pain or heavy periods. Hormonal fluctuations, chronic pain, inflammation, sleep disruption, and medication side effects can all influence emotional health. Understanding why mood changes happen—and how to manage them—can restore a sense of control and improve daily life.

Quick definitions

• Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, often causing pain, inflammation, and scarring. It affects an estimated 10% of reproductive-age women and people assigned female at birth (AFAB). Source: NIH/NICHD.
• Uterine fibroids are noncancerous growths in or on the uterus. They are very common—up to 70–80% of women develop them by age 50, with higher burden and earlier onset among Black women. Source: NIH/NICHD.

Why mood swings happen with endometriosis and fibroids

1) Hormonal fluctuations

Both conditions are hormone-responsive. Estrogen and progesterone levels naturally rise and fall through the menstrual cycle. In people with endometriosis or fibroids, those shifts can be more symptom-triggering—intensifying cramps, bloating, and breast tenderness—and can coincide with emotional changes like irritability, sadness, or anxiety. Some also experience premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome marked by disabling mood symptoms in the luteal phase. Source: NIMH.

2) Pain, stress, and sleep disruption

Chronic pain drives stress hormones and can erode sleep quality. Poor sleep and uncontrolled pain are closely linked to daytime mood swings, brain fog, and lower stress resilience. Over time, the toll of unpredictable symptoms can heighten anxiety and depressive symptoms.

3) Inflammation

Endometriosis is associated with inflammatory signaling in the pelvis. Inflammation and pain can influence neurotransmitters that regulate mood. While research is ongoing, many patients notice emotional symptoms correlate with pain flares.

4) Anemia and low iron

Heavy menstrual bleeding is common with fibroids and can lead to iron-deficiency anemia. Low iron can cause fatigue, brain fog, reduced exercise tolerance, headaches, and can worsen mood and concentration. Evaluating and treating iron deficiency can meaningfully improve energy and emotional stability. Source: NIH Office of Dietary Supplements.

5) Medication side effects

Hormone-directed therapies are central to treating both conditions, but they can affect mood for some people. Examples include:

• GnRH antagonists/agonists (e.g., elagolix; relugolix combination; leuprolide) reduce estrogen to control pain or bleeding. Effective, but can cause hot flashes, sleep issues, and mood changes. FDA information: elagolix (Orilissa) label; relugolix-estradiol-norethindrone (Myfembree) label; elagolix-estradiol-norethindrone (Oriahnn) label.
• Progestins and combined oral contraceptives can stabilize hormones and reduce bleeding and pain. Most people tolerate them well, but a subset experience mood shifts.
• Levonorgestrel-releasing IUDs may lighten bleeding and cramps with lower systemic hormone exposure; mood effects are possible but less common.

If you notice new or worsening mood symptoms after starting a therapy, tell your clinician. Small adjustments—dose changes, switching formulations, or adding “add-back” estrogen/progestin with GnRH agents—can reduce side effects while maintaining symptom control. See FDA labels for detailed safety guidance.

How to tell whether endometriosis, fibroids, or something else is driving mood changes

• Track your cycle and symptoms: Use a diary or app to log pain, bleeding, sleep, and mood. Patterns that cluster before or during periods suggest a hormone-linked component (e.g., PMS/PMDD).
• Check for anemia: If you have heavy bleeding, ask for a complete blood count (CBC) and ferritin.
• Assess pain control: Poorly controlled pelvic pain is a major driver of stress and mood lability. Optimizing pain management often helps emotional symptoms.
• Screen for PMDD or depression/anxiety: Validated tools and a mental health evaluation can guide next steps. NIMH provides PMDD information and treatment options.

Evidence-based ways to manage mood swings

1) Treat the underlying gynecologic condition

• Endometriosis: Options include NSAIDs; hormonal suppression (combined oral contraceptives, progestins); GnRH antagonists/agonists (e.g., elagolix; relugolix combination therapy) with add-back therapy to protect bone and reduce hot flashes/mood effects; and surgery for diagnosis and excision when appropriate. FDA-approved options for endometriosis pain include elagolix and relugolix combination therapy; note bone density risks and treatment-duration limits on labels.
• Fibroids: Options include NSAIDs and tranexamic acid for heavy bleeding; hormonal contraception; levonorgestrel IUD; GnRH analogs/antagonists; and procedures such as uterine fibroid embolization, myomectomy, or hysterectomy depending on symptoms and fertility goals. Relugolix and elagolix combination therapies are FDA-approved to reduce heavy menstrual bleeding associated with fibroids—review labeling for risks and duration limits.

2) Address anemia and nutrition

• Test and treat iron deficiency with dietary changes and, if prescribed, iron supplements. Correcting iron deficiency can improve fatigue, cognition, and mood. Source: NIH ODS.
• Pair iron-rich foods (lean red meat, legumes, leafy greens) with vitamin C sources to enhance absorption; avoid taking iron with calcium or high-tannin beverages.

3) Optimize sleep and pain control

• Use scheduled NSAIDs around the onset of menses if approved by your clinician; add heat, gentle movement, or pelvic physical therapy for pain relief.
• Prioritize 7–9 hours of sleep; consistent bedtimes; limit alcohol and caffeine late in the day.

4) Target cycle-related mood symptoms

• PMDD or severe PMS: Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are effective; SSRIs can be taken daily or only during the luteal phase under clinician guidance. Source: NIMH.
• For milder symptoms, some benefit from aerobic exercise, stress-reduction techniques, and structured routines.

5) Mind-body and support strategies

• CBT, mindfulness-based stress reduction, and support groups can reduce the emotional burden of chronic pelvic pain.
• Consider a multidisciplinary team: gynecology, mental health, primary care, pelvic floor physical therapy, and nutrition.

When to seek care urgently

• Mood swings escalate to thoughts of self-harm or hopelessness—seek help immediately (call your local emergency number or a suicide/crisis hotline; in the U.S., dial or text 988).
• Heavy bleeding causing dizziness, fainting, or signs of severe anemia.
• New, severe pelvic pain or fever.

What to ask your clinician

• Could my mood changes be related to pain flares, PMDD, anemia, or a medication side effect?
• Which treatment options balance symptom relief, mood stability, bone health, and my fertility goals?
• Should I be screened for iron deficiency or a mood disorder? Would an SSRI or CBT help?
• What’s the expected timeline for symptom improvement, and how will we monitor side effects?

The bottom line

Endometriosis and fibroids can drive mood swings through multiple pathways—hormonal shifts, pain, inflammation, sleep loss, and anemia. The good news: mood symptoms often improve when the underlying condition is treated, iron stores are restored, sleep and pain are better controlled, and targeted mental health care is added when needed. Work with your clinician to map your symptoms, personalize treatment, and adjust as you go.

Trusted resources

• NIH/NICHD: Endometriosis and Uterine Fibroids
• NIMH: Premenstrual Dysphoric Disorder (PMDD)
• NIH Office of Dietary Supplements: Iron Fact Sheet
• FDA Drug Labels: Orilissa (elagolix); Oriahnn (elagolix, estradiol, norethindrone); Myfembree (relugolix, estradiol, norethindrone acetate)
• MedlinePlus: Endometriosis; Uterine Fibroids

This article is for educational purposes and is not a substitute for professional medical advice. Always consult your healthcare provider for diagnosis and treatment tailored to you.