For 15 years, Evelyn Scott, age 37, endured excruciating menstrual pain without receiving a diagnosis. Doctors repeatedly dismissed her symptoms, telling her that "to be female is to be in pain." Doctors suggested the problem was her mental health, says Scott, a writer and academic who lives in Guildford, England.
"Clinicians said, 'you are having painful periods because you are depressed,'" Scott recalls. "And I was like, no, no, no, I'm depressed because I'm having painful periods and I can't cope with it."
Finally, a laparoscopic procedure confirmed her diagnosis: endometriosis.
Scott is one of more than 190 million women worldwide living with endometriosis, according to the World Health Organization. Like her, many are misdiagnosed as having mental health issues rather than endometriosis. A 2020 study of U.S. patients revealed a troubling pattern: Nearly half of endometriosis patients surveyed reported that health-care providers had initially attributed their symptoms to mental health issues before correctly diagnosing them with endometriosis. An international study published in 2023, surveying more than 2,000 women across 63 countries, revealed that patients waited an average of 9.6 years for an endometriosis diagnosis. Researchers found that physicians frequently normalized symptoms, and that patients reported that their complaints were often dismissed as unreliable.
Endometriosis affects 10% of women during their reproductive years. It results when tissue similar to the uterine lining grows outside the uterus. This tissue responds to menstrual cycle hormones, leading to pain. Symptoms include chronic pelvic pain, heavy menstrual bleeding, pain during intercourse, painful urination, and bowel movements, along with depression and anxiety.
More than 190 million women worldwide suffer from endometriosis
For Scott, the week of her period became a cycle of anxiety and physical distress. When she sought help, doctors prescribed diazepam, a sedative for sleep and anxiety, dismissing her concerns as hysteria. "You're not any worse than anybody else," her family physician said.
The impact was devastating: Scott regularly missed weeks of classes throughout school, college, and university. The disruption to her life led to depression, forcing her to cancel plans repeatedly because of what doctors insisted was normal menstrual pain.
Hugh Taylor, chair of obstetrics, gynecology, and reproductive sciences at Yale University, notes a complex relationship between endometriosis and mental health: "Anxiety and depression are common in women with endometriosis. They may see a psychiatrist before they actually get to diagnosing the endometriosis. I think we need more awareness of the systemic effects of endometriosis."
Endometriosis and mental disorders connect through multiple pathways. Taylor explains, "The endometriosis from the pelvis and elsewhere sends inflammatory signals and small molecules to the brain. These signals and molecules change brain gene expression and electrophysiology." He demonstrates that these changes lead to behavioral symptoms such as depression and anxiety. Taylor and his colleagues discovered these connections by inducing endometriosis in female mice. "The impact of endometriosis on the brain is incredibly common, but underrecognized and underappreciated," Taylor emphasizes.
Besides this direct biological pathway, chronic pain creates another link between endometriosis and mental health issues. Although pain is the central symptom of endometriosis, women often endure severe pain without seeking diagnosis for two reasons. First, menstrual pain holds a unique position in human experience—it's the only type of pain society normalizes. "Any other pain that you have anywhere, you would get it evaluated," Taylor notes. "But menstrual pain is routinely accepted as normal, despite its subjective nature." This normalization of pain is deeply embedded in gender dynamics, as Scott discovered when female relatives insisted that "periods are supposed to be painful."
Second, cultural taboos around menstruation create additional barriers to seeking help. Zahra Poursoleimanamiri, an architect living in Iran, knows this firsthand. Poursoleimanamiri waited six years to receive her endometriosis diagnosis. She had consulted approximately 12 physicians, she said, all of whom had dismissed her symptoms as normal before the diagnosis. The undiagnosed condition severely affected her daily life, interfering with her ability to concentrate and triggering progressive anxiety. A psychologist told her that her symptoms were merely pain catastrophizing, a manifestation of life problems.
Poursoleimanamiri says that cultural taboos restricted her ability to discuss symptoms, not only with men. "I can't even talk about this illness with women. They tell me, 'Why do you talk so much about your illness and symptoms?'" she says, illustrating how cultural stigma can silence those seeking support. This limitation causes many women to self-censor their symptoms and feelings.
Cultural taboos around menstruation create additional barriers to seeking help
A research paper published in 2025 identifies several factors influencing the mental health of endometriosis patients: fear of infertility and uncertainty about relationships, chronic pelvic pain that limits daily activities, and sexual dysfunction. The researchers emphasize that the widespread comorbidities of this disease require increased awareness among all medical specialties, not just gynecologists.
"It's very common for physicians not to know the symptoms of endometriosis," says Amanda Della Giustina, a clinical research associate who recently completed her post-doctoral research at the Ottawa Hospital Research Institute. In a 2024 editorial for Clinics, Giustina and her colleagues advocated for redefining endometriosis: "It is time for the health-care and scientific communities to recognize endometriosis no longer as a pelvic, but rather a systemic condition."
Giustina emphasizes that despite substantial evidence linking psychiatric conditions to endometriosis, health systems fail to train clinicians to recognize these connections. This knowledge gap contributes to prolonged diagnostic delays because practitioners often miss the relationship between mental health symptoms and the underlying condition. "Many women experience anxiety and depressive symptoms but they don't know why it could be related to the endometriosis," she says.
Recently, researchers have called for a comprehensive approach to endometriosis care. A 2024 study suggests health-care providers should view endometriosis as a lifelong condition that requires multiple specialists to work together. This collaborative approach improves patients' quality of life and mental health outcomes. Mental health support and group therapy can also help patients feel more supported, the authors wrote. Although endometriosis was historically treated with basic gynecological interventions, evidence now shows the need for multidisciplinary care at all levels, including dietitians, physiotherapists, and psychologists.
The oversight of endometriosis's psychological impact extends beyond the initial diagnosis. Both Scott and Poursoleimanamiri said that after receiving their clinical diagnoses, their physicians neither referred them to mental health professionals nor informed them about a connection between endometriosis and psychological distress. Poursoleimanamiri experienced significant depression and grief over her lost reproductive ability following a hysterectomy performed as part of her treatment protocol.
Scott also described experiencing anxiety, depression, and some suicidal thoughts—which could have been prevented with more appropriate care. Had physicians explained that the disease could affect her mental well-being, she would have better understood what to expect long term and "wouldn't feel left in the dark," Scott says.
