Endometriosis and Mental Health


Mental health is a critical component of a woman’s treatment for endometriosis

Karen Louise Horst, MD

As a reproductive psychiatrist, Dr. Karen Horst has seen the toll endometriosis pain can take on a woman’s mental health.

Her advice is robust, but it starts with early action. “The earlier patients receive the emotional support they need, the better their outcomes are,” said Dr. Horst, a women’s health specialist at Texas Children’s Pavilion for Women and an Assistant Professor at Baylor College of Medicine.

“The majority of endometriosis patients I treat come to me for help with anxiety and depression, common comorbidities for this disease.

The chronic pain of endometriosis makes their lives very difficult. Women with this condition suffer from excruciating pain. They also feel very isolated because the pain isn’t something most women experience. It’s awful, isolating suffering. And it’s often dismissed initially. The endometriosis patients I see have typically been down this painful road for quite a while,” she noted.

Removing the stigma of mental healthcare

Endometriosis is a physical condition that trains your nervous system to be in a chronic pain loop, Dr. Horst explained. That chronic pain causes stress in the woman’s life, which then leads to mood disorders.

“We need to remove the stigma of getting mental healthcare and use all the tools we have to improve the quality of life for these patients, including mental health tools for managing their pain, regulating the nervous system, and reducing the anxiety and depression caused by this condition,” she added.

Dr. Horst also treats endometriosis patients who are suffering from menopause symptoms brought on by their treatment, such as hormone-blocking therapy or an early hysterectomy. The sudden withdrawal of estrogen and progesterone can cause anxiety, depression and insomnia.

Other endometriosis patients are referred to her for help coping with pain during intercourse, known as dyspareunia, another common symptom of the disease. “Pain with penetration impacts their intimacy, their relationship, and just that ability to be a sexual person and feel like you’re able to fully be with your partner,” said Dr. Horst.

A critical element of treatment for every endometriosis patient is normalizing the woman’s symptoms and assuring them it’s not in their head,” she added. “Validating is medicine in and of itself.”

A proven, comprehensive treatment strategy

Patient care is provided through The Women’s Place at Texas Children’s Pavilion for Women, one of only a handful of programs in the United States specializing in women’s reproductive mental health care, including evaluation, diagnosis and treatment of mood or psychiatric conditions during pregnancy, postpartum, or perimenopause, as well as mood and anxiety disorders related to infertility, menstrual cycles, hormonal changes or chronic pelvic pain from endometriosis.

“Our reproductive psychiatrists are part of a team of Baylor experts from a wide range of specialties that work together to provide women timely diagnosis and effective treatment for endometriosis, helping them through this painful condition,” Dr. Horst said. “Mental health support is an important part of that strategy.”

Recognizing the signs of anxiety and depression

Types of anxiety

  • Panic attacks – episodes of physical anxiety that involve a sudden rush of adrenaline
  • Panic disorder – repeated panic attacks that lead to the fear of having a panic attack
  • Generalized anxiety – anxiety characterized by worrying, muscle tension, insomnia, a tendency to catastrophize, and to project into the future instead of being more present
  • Phobias – anxiety focused on something specific, such as a fear of flying

Types of depression

  • Depressive mood — a feeling of depression with negative thoughts, sadness, struggles with motivation, and other symptoms, but the ability to function
  • Dysthymic disorder, or persistent depressive disorder — a depressed but functional state that lasts at least two years
  • Episodic depression — deep depression that impacts the ability to function normally
  • Major depression — the most severe form of depression with multiple symptoms that persist for at least two weeks

To learn more about endometriosis and the toll it takes on millions of lives, join the department of Obstetrics and Gynecology at Baylor College of Medicine as we host a special screening of “Below the Belt,” a powerful documentary on women’s health and healthcare told through the lens of endometriosis. This must-see documentary will be followed by a panel discussion with Baylor endometriosis specialists. Reserve your spot today.