Trauma Linked to Increased Risk of Endometriosis

A new international study, which included contributions from the University of Barcelona, has identified a potential connection between traumatic experiences and the development of endometriosis, a chronic inflammatory condition in which endometrial-like tissue grows outside the uterus. The findings suggest that physical trauma – such as experiences involving direct contact, including physical abuse and sexual assault – may be particularly relevant.

Through genetic analysis, the researchers found that this association appears to be independent of genetic predisposition to endometriosis. The study, published in JAMA Psychiatry, may have implications for early diagnosis of the disease, which affects approximately 190 million women of reproductive age globally.

Large-scale analysis of trauma and endometriosis

The study examined data from 8,276 women diagnosed with endometriosis and 240,117 controls within the UK Biobank, a biomedical resource containing genetic, lifestyle and health information. The analysis revealed that individuals with endometriosis were more likely to report certain traumatic experiences.

For instance, women with endometriosis were found to be:

• 17% more likely to have witnessed a sudden death
• 16% more likely to have experienced sexual assault in adulthood
• 36% more likely to have received a life-threatening diagnosis

To further explore these connections, the researchers conducted a latent class analysis, a statistical method used to identify patterns within data. The results suggest that emotional, physical and sexual trauma may contribute to the development of endometriosis.

Genetic correlations and childhood trauma

The study incorporated genome-wide association studies (GWAS) to analyze genetic links between trauma and endometriosis. The findings indicated that endometriosis shares genetic correlations with conditions related to trauma, with the strongest associations observed for post-traumatic stress disorder (PTSD) and childhood abuse.

Additionally, childhood experiences – such as feeling unwelcome in the family or experiencing physical abuse – were found to be associated with endometriosis. The researchers suggest that early adverse experiences may influence the risk and progression of the disease.

Other identified links included childhood access to medical care. Having caregivers who facilitated doctor visits was associated with reduced risk of developing endometriosis, possibly due to improved stress resilience and health-seeking behaviors.

Mechanisms beyond genetic predisposition

The study found no direct gene-environment interactions that could explain the connection between trauma and endometriosis. Instead, the relationship appeared to be mediated by gene-environment correlations. This means that individuals with certain genetic traits may be more likely to experience or recall traumatic events, which could subsequently influence disease risk.

The results align with a reclassification proposed by one of the study’s co-authors, suggesting that endometriosis should be considered a chronic systemic disease with effects beyond the reproductive system. These findings highlight how trauma, both in childhood and adulthood, may contribute to the development of the condition through mechanisms independent of genetic predisposition.

Potential implications for early diagnosis

The observed associations between trauma and endometriosis align with previous research linking the disease to mental health conditions, including depression, anxiety and eating disorders. These findings underscore the importance of a holistic approach to patient care that considers both physical and mental health.

While further studies are needed to confirm these results in diverse populations, the research suggests that incorporating a history of trauma into screening programs could improve early detection and management of endometriosis. By considering both genetic and environmental risk factors, healthcare providers may be able to offer more comprehensive care for individuals affected by the disease.

Reference: Koller D, Løkhammer S, Goroshchuk O, et al. Observational and genetic analyses of traumatic experiences and endometriosis. JAMA Psychiatry. 2025. doi: 10.1001/jamapsychiatry.2024.4694

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