Bi-Directional Relationship Seen Between Endometriosis, Psychiatric Disorders

By Anne Harding

March 06, 2020

NEW YORK (Reuters Health) - Endometriosis is linked to an increased risk of developing several psychiatric disorders, some of which are also associated with a higher risk of receiving a subsequent diagnosis of endometriosis, new findings show.

"Our study suggests that women with endometriosis had higher risk for comorbidities with a broad spectrum of psychiatric disorders. This should be taken account in the care of these women which has to be from a multidisciplinary perspective," Menghan Gao and Dr. Kyriaki Kosidou of Karolinska Institutet in Stockholm, two of the study's authors, told Reuters Health in a joint email.

"Clinical practice should consider psychosocial support to women with endometriosis and effective management of their physical and mental illness comorbidities," the authors added. "It is also possible that treatment of the psychiatric comorbidity might relieve the psychological suffering caused by the disorder."

Endometriosis has been linked to depression, anxiety and bipolar disorder, Gao and Dr. Kosidou and their colleagues note in the American Journal of Obstetrics and Gynecology. To investigate further, the authors looked at registry data for more than 854,000 women born in Sweden in 1973-1990, including a subset of 6,009 families with two or more daughters discordant for endometriosis.

During 1987-2016, 14,144 women (1.7%) were diagnosed with endometriosis. Overall, 13.1% of the sample had anxiety and stress-related disorders and 9.3% had depressive disorder.

Endometriosis was significantly associated with an increased risk of all psychiatric disorders, except for autism spectrum disorder, with the highest risk seen for alcohol-/drug-dependence disorders (hazard ratio, 1.93).

The risks of depressive disorders, anxiety and stress related disorders, alcohol-/drug-dependence disorders, and attention-deficit/hyperactivity disorder (ADHD) were higher for women with endometriosis compared to their unaffected sisters, with hazard ratios ranging from 1.56 for depression to 1.98 for ADHD.

All of the psychiatric disorders, aside from non-affective psychiatric disorders, were also linked to an increased risk of subsequently receiving an endometriosis diagnosis, with HRs ranging from 1.26 for alcohol or drug dependence to 1.94 for anxiety and stress related disorders.

Because the study was registry-based, detailed data was not available on disease occurrence and progression, "which might limit the interpretation of the direction of the associations found in our study," Gao and Dr. Kosidou said.

"We have (to consider) whether it is possible to prevent psychiatric comorbidities in these women," they added. "To this end, we need to better understand the causes of the comorbidity of endometriosis with psychiatric disorders, whether it is explained by common causes, such as genetic or other early-life influences and environmental factors, or whether some part of the comorbidity is due to the consequences of endometriosis such as pain and fertility problems."

SOURCE: American Journal of Obstetrics and Gynecology, online February 26, 2020.