Everyone experiences stress from time to time. Tension, racing thoughts, and mood changes can be signs of stress. You may also experience physical effects of stress such as fatigue, digestive changes, and pain.

The connection between stress and endometriosis is complicated. Some research suggests stress can make symptoms worse. And living with a chronic condition like endometriosis can be stressful. Factors like pain, unpredictable flares, and fertility challenges can be huge stressors.

Over time, chronic stress can take a toll on your physical and mental health. About half of people living with endometriosis also experience anxiety or depression. This is a much higher percentage compared to rates of depression in the general population.

Finding ways to cope with stress can help with your mental health. Stress management may also help you better manage endometriosis symptoms.

Our bodies have a highly coordinated system designed to respond to acute, short-term stressors. It’s meant to help you manage temporarily stressful situations, and it’s often known as the “fight, flight, or freeze” response.

Over time, with chronic ongoing or unmanaged stress, this response can start to damage the body.

Stress can also affect the gut microbiome. We have complex communities of bacteria living in and on our bodies. It’s known as the microbiome. Most of the microbiome lives in the digestive tract.

Stress can throw off the balance of good bacteria in the gut. This imbalance is known as dysbiosis.

Dysbiosis is associated with certain inflammatory conditions, including endometriosis, though it’s not clear what comes first. It’s possible the inflammation of endometriosis causes dysbiosis. It’s also possible that dysbiosis initiates inflammation that leads to the development of endometriosis.

The gut microbiome is also thought to play a role in the metabolism of estrogen. Research has found that dysbiosis can increase the amount of estrogen in the body, and endometriosis growth is driven by increased estrogen levels.

This is what we know so far about stress and the development of endometriosis. More research is needed to better understand this complex link.

In one 2018 study of animal models, stress was found to be associated with an increase in endometriosis lesions. It also showed that stress increased the number of endometrial vesicles.

Vesicles are tiny transport vessels that move various materials between cells in the body. Research has found that these vesicles may play a role in the spread of endometriosis lesions. Vesicles are also thought to be associated with higher levels of inflammation in the body.

These vesicles may also play a role in diagnosing endometriosis in the future. Currently, diagnosis involves laparoscopic surgery. One day, a less invasive vaginal or cervical swab may be used in place of surgery. It’s thought the number of endometrial vesicles found in these samples may help confirm an endometriosis diagnosis.

While this is what research suggests so far, there’s much more to learn in this area.

The relationship between stress and pain is cyclical. Pain can increase stress levels, and the body’s stress response can increase pain.

A 2018 study in animal models found that stress increased the growth of nerve fibers. Nerve fibers play many roles, including sending pain messages to the brain. Nerve growth factor is a protein that supports the development of nerve fibers. Increased levels of this protein are seen in people who experience higher levels of endometriosis pain.

Pain also takes a toll on your mental health. Research shows that people who experience chronic pelvic pain have higher levels of depression compared to those who don’t experience this type of pain.

It’s impossible to avoid stress altogether. That’s why it’s important to teach your mind and body how to adapt to and cope with stressors. This helps your body come down from the fight, flight, or freeze response and return to more of a relaxed state.

Try these stress management strategies to help break the chronic stress cycle and manage endometriosis.


Staying active can improve your mood and help relieve stress. Exercise can also help to reduce inflammation in the body.

One 2019 study explored the effects of exercise on endometriosis lesions in rats. The rats were divided into groups based on exercise frequency: one, three, or five weekly sessions. Results found that all groups experienced reductions in endometriosis lesions. Increased exercise frequency was associated with greater stress reduction.

The idea of exercise can feel daunting if you’re not feeling well or you’re living with chronic pain. Consider working with a physical therapist who can support you in finding a fitness plan that works for you.


Yoga is an ancient practice from India. It involves a sequence of multiple poses, stretches, and breathing techniques.

Yoga provides a variety of health benefits. It helps boost strength, flexibility, and relaxation. Yoga can also be an effective way to manage stress and anxiety. It can even play a role in managing chronic pelvic pain related to endometriosis.

One 2017 study found that, after following an 8-week yoga program, participants experienced an improvement in chronic pelvic pain.


Mindfulness is the purposeful act of being present in any given moment. Practicing mindfulness can help manage feelings of anxiety, depression, and stress. Results from a 2019 review found that mindfulness may also help with the stress and pain of endometriosis.

Here are a few simple ways to get started with mindfulness:

  • Practice deep breathing and focusing on your breath.
  • Close your eyes. Make note of the sounds you hear around you.
  • Try a full body scan: Start with your toes and work your way up your body. Notice what you’re feeling along the way.
  • Sit quietly for a few minutes. Make note of the thoughts that are floating in your mind.
  • Focus your attention on what you can see right in front of you.

You can also look into classes, guided meditation sessions, or books about mindfulness.


Consider working with a therapist. They can teach you unique ways to cope with your individual stressors. A therapist can also help you develop skills to manage your thoughts and feelings.

Ask your doctor for a referral to a therapist, if you need one.

Endometriosis and stress are interconnected. Living with a chronic condition like endometriosis can increase stress and make it hard to cope. Stress is also thought to increase inflammation in the body and make endometriosis symptoms worse.

Taking steps to manage stress can help with endometriosis symptoms. Options like exercise, yoga, and mindfulness may be beneficial. Consider connecting with a therapist to learn other stress management skills.