Mental Health And Endometriosis and Fibroids: What to Know

September 13, 2025

Mental Health And Endometriosis and Fibroids: What to Know

Endometriosis and uterine fibroids are common gynecologic conditions that can profoundly affect daily life. Beyond physical symptoms like pain and heavy bleeding, these conditions can influence mood, sleep, relationships, and work. Understanding the mind–body connection—and the resources available—can help you or a loved one navigate care with more confidence.

Quick facts: How common are they?

Endometriosis: Estimated to affect about 10% of women of reproductive age, endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, often causing pelvic pain, painful periods, and sometimes fertility challenges (NIH/NICHD).
Uterine fibroids: Noncancerous growths of the uterus that may cause heavy menstrual bleeding, pelvic pressure, and pain. Most women will develop fibroids by age 50, and they tend to occur earlier and be more severe in Black women (NIH/NICHD).

How these conditions affect mental health

The psychological impact is real and multifaceted. Research shows people living with endometriosis or fibroids experience higher rates of depression and anxiety than those without these conditions, largely driven by chronic pain, uncertainty, and disruptions to daily life. Several factors contribute:

Chronic pain and stress: Recurring pelvic pain can disrupt sleep, limit activity, and heighten stress responses, which can worsen pain perception over time. This “pain–stress” cycle can fuel low mood and irritability.
Heavy bleeding and fatigue: Fibroid-related heavy menstrual bleeding can lead to iron-deficiency anemia, causing fatigue, shortness of breath, and difficulty concentrating—symptoms that can mimic or worsen depression and anxiety (NIH/NHLBI).
Sexual health and relationships: Pain with intercourse (dyspareunia) and unpredictable symptoms can affect intimacy, self-image, and relationship satisfaction.
Fertility concerns: Both conditions can be associated with fertility challenges for some, adding emotional stress, grief, or fear about the future (NIH/NICHD).
Stigma and delays in diagnosis: Period pain and bleeding are often dismissed, which can delay diagnosis and treatment. Feeling unheard or invalidated can compound distress.

Signs it may be time to ask about mental health support

Physical and emotional symptoms often overlap. Consider discussing mental health with your clinician if you notice:

Persistent sadness, hopelessness, or loss of interest in activities
Uncontrolled worry, panic, or irritability
Sleep disturbance, exhaustion, or “brain fog” that doesn’t improve
Thoughts of self-harm or feeling unsafe (seek immediate help by calling local emergency services or a crisis hotline)

Clinicians may use validated screening tools to assess symptoms and recommend care, which can include therapy, medications, or both (NIMH).

Treatment options that may ease both physical and emotional burden

Addressing the underlying gynecologic symptoms often improves quality of life and mental well-being. Treatment is individualized based on symptoms, goals, and medical history.

Endometriosis

Pain relief and hormonal therapy: Nonsteroidal anti-inflammatory drugs (NSAIDs), combined hormonal contraceptives, and progestin-only options (including the levonorgestrel intrauterine system) can reduce pain and bleeding for many (NIH/NICHD).
GnRH modulators: Oral GnRH antagonists such as elagolix are FDA-approved to treat pain associated with endometriosis; they lower estrogen levels to reduce pain but may cause side effects like hot flashes and loss of bone mineral density, so duration is typically limited and monitoring is important (FDA).
Surgery: Laparoscopic surgery to remove endometriosis lesions can relieve pain for some patients. Decisions depend on symptom severity, fertility goals, and prior treatment response.

Uterine fibroids

Medical therapy: NSAIDs and tranexamic acid can help with bleeding and pain. Hormonal birth control and the levonorgestrel IUD often reduce heavy bleeding (NIH/NICHD).
GnRH modulators: FDA-approved oral combination therapies—elagolix with add-back hormones and relugolix combination therapy—are options for heavy menstrual bleeding due to fibroids. These can reduce bleeding and improve anemia; clinicians monitor for risks like bone loss and, with add-back therapy, potential clot risk (FDA).
Procedures and surgery: Options include myomectomy (removes fibroids, preserves uterus), uterine artery embolization, radiofrequency ablation, MR-guided focused ultrasound, and hysterectomy. Choice depends on symptoms, size and location of fibroids, and fertility plans (NIH/NICHD).

Because severe symptoms can drive anxiety and depression, integrating gynecologic treatment with mental health care often yields the best outcomes.

Coping strategies backed by evidence

Collaborative care: Ask your OB-GYN about a team-based approach that includes a mental health professional and, when appropriate, a pain specialist or pelvic floor physical therapist.
Therapies that build skills: Cognitive behavioral therapy (CBT) and mindfulness-based strategies can reduce pain-related distress and improve functioning. Many people benefit when therapy is combined with medical treatment.
Sleep and iron status: Treating anemia and practicing good sleep hygiene can improve energy, concentration, and mood. If your periods are heavy, ask about iron testing and replenishment (NIH/NHLBI).
Physical activity: Gentle, regular movement (e.g., walking, yoga, stretching) can ease pain and support mood. Start low and go slow on flare days.
Nutrition and flares: Eating a balanced diet and staying hydrated supports overall well-being; some people identify personal food triggers, but there is no one “endo” or “fibroid” diet endorsed by NIH.
Peer support: Support groups—online or in person—can reduce isolation and offer practical tips for work, school, and relationships.

Equity and access matter

Fibroids disproportionately affect Black women, who are more likely to have earlier onset, larger or more numerous fibroids, and more severe symptoms (NIH/NICHD). Advocating for timely evaluation and culturally competent care is essential. If your symptoms are dismissed, consider seeking a second opinion.

Preparing for your appointment

Track pain, bleeding (including pad/tampon counts), and triggers for 1–2 cycles.
List all medications, including over-the-counter pain relievers and supplements.
Note mental health symptoms (mood, anxiety, sleep, concentration) and how they affect work, school, or relationships.
Discuss family planning goals and preferences about medical vs. surgical care.

When to seek urgent help

Seek immediate care for severe bleeding (soaking through products every hour for several hours), fainting, severe or worsening pain, fever with pelvic pain, or thoughts of self-harm. In the U.S., you can call or text 988 for mental health crises.

The bottom line

Endometriosis and fibroids can take a toll on both body and mind. The good news: effective treatments exist, and addressing mental health alongside gynecologic care can significantly improve quality of life. Partner with your clinician, ask about evidence-based options—including FDA-approved therapies when appropriate—and don’t hesitate to include mental health support as part of your plan.