Did you know that endometriosis can also negatively affect your mental health? In fact, women with endometriosis are twice as likely to suffer from a mental health condition. The month of March is Endometriosis awareness month. It really sounds like woman are celebrated a lot and commemorate so much. Or is it that women actually do go through a great deal of complicated scenarios, over varied periods, monthly, every nine months, annually and in some cases for as long as they are alive. For a long time not much has been openly said with regards to their sexual and reproductive health. Culturally these conversations are swept under the carpet, or mumbled in the presence of few or taken as “every woman braves through it, there is nothing new.” Yet statistics now tell a different story, a recent meta-analysis of studies of women with endometriosis found that more than two-thirds (68%) had mild or high psychological stress.
Endometriosis is a common, often painful condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus. The most common symptom of endometriosis is chronic pelvic pain, especially just before and during the menstrual period. Endometriosis is also associated with mental health conditions not limited to, but including, depression, anxiety and a reduced quality of life psychologically. The ongoing pain can affect a person’s daily life. One diagnosis that tops the list is of the most common psychological condition associated with endometriosis is depression, a mood disorder that causes feelings of sadness and hopelessness.
Potentially contributing to the psychological distress is the challenge many women face in even getting to a diagnosis. It is often years after symptoms begin before a diagnosis and delays of four to six years are common. Among the reasons identified for the delays are patient issues such as stigma, embarrassment and uncertainty about normal versus abnormal symptoms, physician-centred causes such as normalization of symptoms, and lack of a non-invasive diagnostic test. Likewise culture is not spared, it ranks as one of the highest reason that discourages women to seek psychological help with regards to their condition. Women’s significant chronic pain is often not understood, not taken seriously or dismissed as ‘typical menstrual pain’ by health care professionals.
One recent study found that women with endometriosis “often encountered the attitude that they exaggerated or imagined their symptoms or had low pain thresholds” and women were told their menstrual pain was normal. On the other hand, very women described other health care experiences where they felt acknowledged understood. The constructive experiences “made the women’s self-esteem grow, as they felt confirmed and visible.”
A study by Laganà et al investigated quality of life, negative emotions, such as anger, anxiety and depression, and possible psychopathological comorbidity in a sample of 166 women with endometriosis. Patients completed the following self-report instruments: Symptom Checklist-90-R, State-Trait Anger Expression Inventory-2, Self-Rating Anxiety Scale, Self-Rating Depression Scale and Quality of Life Index. The results showed that somatization, depression, sensitivity and phobic anxiety are higher in these patients than in women without endometriosis. Moreover, the same authors found that women with endometriosis are characterized by high levels of anxiety and a significant decline in quality of life.
This severe, ongoing pain can significantly affect a person’s everyday life. They may have to call in sick to work or school, cancel plans with friends, and withdraw from intimate relationships because of their symptoms. As a result, the state of their mental health can be greatly affected.

Women with endometriosis alongside anxiety may also have  lower self-esteem and a more negative body image. This is highly attributed to the functional limitations of their bodies. On the other hand, it can also be a result of physical changes that many people with endometriosis experience, these include; surgery scars, unintentional weight gain from hormonal therapy, tiredness and lethargy from heavy bleeding and anaemia. In some cases menopause symptoms such as hot flashes, fatigue, reduced libido, and vaginal dryness are present when one has endometriosis and this is a debilitating state for any young and middle aged woman to be in. Some research also indicates a link between endometriosis and changes in brain chemistry. According to three neuroimaging studies involving patients with endometriosis, brain regions related not only to pain processing but also to emotion, cognition, self-regulation and reward likely constitute the so-called “endometriosis brain”. It is not clear, however, whether the neurobiological changes seen in these patients are caused by chronic pain, mental comorbidities or endometriosis itself.

It is recommended that interdisciplinary treatment should not only address pain management and potential infertility, but also mental health support. Although endometriosis is a relatively common condition, it is still poorly understood, and culturally considered to be a norm amongst young women, hence not a condition to cause concern. Many women still have difficulty accessing the support they need, as a result of this. It is time for awareness to be intensified so that women are not ashamed of this condition, get a deeper understanding of their bodies and coping mechanisms associated with such a condition. Support groups are an excellent option for those with endometriosis as they provide emotional support, guidance, and knowledge from others living with the condition. In addition, if women living with endometriosis develop depression, a support group focusing on sexual and reproductive health related depression can help one feel less isolated.


TAFADZWA MEKI



INTERN COUNSELLING PSYCHOLOGIST

MENTAL HEALTH ADVOCATE
FOUNDER, S.A.L.T AFRICA