Epidemiologic and Genetic Associations of Endometriosis With Depression, Anxiety, and Eating Disorders
Comprehensive Overview
This study, published in JAMA Network Open (2023), investigated whether endometriosis, a chronic condition in which tissue similar to the uterine lining grows outside the uterus and often causes severe pelvic pain, shares underlying biological roots with depression, anxiety, and eating disorders, conditions long known to occur more often in women with endometriosis. While chronic pain has generally been assumed to explain this overlap, animal research has suggested endometriosis may affect mood independently of pain, raising the question of whether shared genetic factors, rather than pain alone, might help connect these conditions. Researchers analyzed genetic and health record data from more than 8,000 women with endometriosis and nearly 194,000 women without the condition, drawn from a large UK health database, and combined this with genetic data from several other large international research collaborations. They examined whether endometriosis and each psychiatric condition tended to occur together more than expected by chance even after accounting for numerous other health and lifestyle factors, whether the conditions shared genetic underpinnings, and, using a genetic technique that can help estimate cause-and-effect relationships, whether one condition might genetically contribute to the risk of developing the other.
Outcomes and Implications
The most notable finding was that women with endometriosis had substantially higher odds of all three psychiatric conditions studied, even after accounting for age, weight, socioeconomic status, and chronic pain-related symptoms, with roughly a 3 to 4 times higher likelihood of depression, nearly a 3 times higher likelihood of eating disorders, and roughly a 2.5 times higher likelihood of anxiety compared with women without endometriosis. These phenotypic patterns were mirrored at the genetic level, with the strongest shared genetic overlap found between endometriosis and eating disorders, and somewhat weaker but still significant overlap with depression and anxiety. Using a genetic analysis technique designed to help infer causal relationships, researchers found evidence that a genetic tendency toward depression and anxiety was associated with increased odds of developing endometriosis, suggesting these mental health conditions may genuinely contribute to endometriosis risk rather than simply resulting from it. Researchers also identified a specific gene, DGKB, that appears to influence both endometriosis and depression, offering a potential shared biological pathway involving inflammation and hormone regulation. This matters because it challenges the common assumption that psychiatric symptoms in women with endometriosis are driven solely by chronic pain, suggesting instead that shared underlying biology plays a meaningful role in this comorbidity. The authors conclude that these findings support viewing endometriosis as a systemic disease affecting both physical and mental health, and highlight the importance of addressing psychiatric symptoms as part of comprehensive endometriosis care.