Written by : Cerise Chisholm for YETIRISE

Published: 9th December 2025

Abstract :

Endometriosis is a chronic inflammatory condition in which cells similar to those found in the uterus grow outside the uterine cavity. It affects approximately 10% of women of reproductive age worldwide. Despite its prevalence, the aetiology of endometriosis remains incompletely understood, and no definitive cause has been established.

This report aims to explore the under-studied association between early-life abuse and adverse childhood experiences (ACEs) and the likelihood of being diagnosed with endometriosis later in life. Although research in this area is limited, existing evidence suggests that such experiences may be linked with an increased risk of developing endometriosis.

The association appears to be correlational rather than causal. Observations indicate that individuals with a history of trauma may utilise healthcare services more frequently due to chronic pelvic pain from other causes, potentially contributing to higher detection rates. While several studies show a slight but statistically significant correlation, conclusions are limited by methodological constraints, including reliance on self-reported abuse and inconsistent diagnostic standards.

Overall, current evidence supports a biopsychosocial framework, in which childhood trauma may interact with biological predispositions to influence endometriosis risk and symptom expression. Further longitudinal research is necessary to clarify causal pathways, establish temporal relationships, and explore therapeutic implications.

This report examines three studies investigating the association between childhood abuse and endometriosis. By comparing their methodologies, findings, and limitations, this article seeks to clarify existing evidence, identify knowledge gaps, and guide future research aimed at improving understanding and management of endometriosis.

Introduction :

As noted, endometriosis is characterised by the presence of endometrial-like tissue outside the uterine cavity, most commonly located within the pelvic region on organs such as the ovaries, fallopian tubes, and bladder, though it can also appear in other areas of the body. This condition can cause chronic pelvic pain, heavy and painful menstruation, infertility, dyspareunia (pain during sexual activity), and a range of other complications. The underlying causes of endometriosis remain only partially understood.

The purpose of this report is to examine a topic that is not often discussed in the context of endometriosis this being the potential link between adverse childhood experiences, abuse, and the development of endometriosis later in life. Prior to conducting this research, even with a background in forensic psychology, I had not considered the possible connection between early-life trauma and this condition. My understanding of endometriosis was largely biological, informed by online research and personal testimonies.

The literature reviewed in this report suggests a significant correlation between early-life trauma and subsequent diagnosis of endometriosis. This report seeks to shed light on this underexplored factor and to encourage broader discussion. By highlighting these links, it is hoped that other potential risk factors or catalysts associated with endometriosis may be investigated, leading to improved understanding and more comprehensive care for those currently dealing with the condition and future cases of endometriosis.

Historically, research on endometriosis has focused primarily on biological explanations. These include:

  • Retrograde menstruation: the backward flow of menstrual blood through the fallopian tubes into the abdominal cavity.

  • Genetic predisposition: inheritance of the condition from a close family member.

  • Immune dysfunction: alterations in immune system functioning in women with endometriosis, potentially contributing to fertility issues and chronic inflammation.

  • Hormonal influences: particularly oestrogen, which stimulates the growth of endometrial-like tissue.

 

However, increasing evidence indicates that endometriosis may result from a complex interplay of biological, psychological, and environmental factors, consistent with a biopsychosocial model. This report focuses on the emerging research linking adverse childhood experiences (ACEs) and childhood abuse to the later development of endometriosis.

Childhood trauma can have lasting effects on neuroendocrine function, disrupting systems that integrate neural and hormonal regulation. These disruptions can affect immune function and pain processing—all systems implicated in endometriosis. Consequently, researchers have begun investigating whether early-life stressors, abuse, and adverse experiences may increase vulnerability to the disorder or exacerbate symptom severity.

Although existing literature indicates a potential association between childhood abuse and endometriosis, the nature of this relationship remains unclear. It is not yet established whether childhood trauma contributes directly to disease development or influences pain perception, symptom reporting, or healthcare-seeking behaviour. Variations in study methodology, including definitions of abuse, sample sizes, and diagnostic criteria, further complicate interpretation. Comparing current research is therefore essential for advancing understanding of how childhood trauma may intersect with gynaecological health.

It is also important to consider disparities in research and clinical practice. Black women with endometriosis are often diagnosed later than white women, sometimes by several years, due to factors such as medical bias, socioeconomic barriers to specialist care, and misattribution of symptoms to other conditions.

For instance, Fillingim et al. (2009) in “Sex, gender, and racial/ethnic differences in pain” demonstrated how social context, coping strategies, cultural background, and structural factors like access to healthcare influence pain perception, reporting, and treatment outcomes. Taylor (2024), in “Black Women’s Experiences of Reaching a Diagnosis of Endometriosis,” highlights how racial and gender-based discrimination contributes to delayed diagnosis, emotional distress, and symptom misattribution in the UK.

Black women with histories of childhood abuse may face a triple vulnerability: increased risk for chronic pain and inflammation due to trauma-related physiological changes; delayed recognition of symptoms due to racial bias in healthcare; and psychological distress from abuse, which can exacerbate pain perception and reduce quality of life. This combination may lead to more severe or prolonged endometriosis symptoms and greater barriers to care.

Study Summaries :

Study 1

Early life abuse and risk of endometriosis

Harris et al. (2018)

Purpose :

The study aimed to investigated whether physical and sexual abuse experienced in childhood or adolescence is associated with the risk of laparoscopically confirmed Endometriosis in adulthood.

Research Design / Methodology :

This was a prospective cohort analysis, meaning an observational study followed a sample group over time to assess how different risk factors are associated with health outcomes, using data from the Nurses’ Health Study II (NHS II). The sample included 60,595 premenopausal women, with follow-ups from 1989 to 2013. Exposure to childhood and adolescent abuse was assessed through a “violence victimisation” questionnaire that was administered in 2001.

Key Findings :

Women who reported early life physical or sexual abuse had a higher risk of developing endometriosis compared to those reporting no abuse. The risk was especially elevated in women who experienced severe-chronic abuse of multiple types of abuse where this group had a 79% higher risk of laparoscopically-confirmed endometriosis. There was evidence of a dose–response relationship where greater severity, chronicity, or accumulation of abuse types corresponded to higher risk. When types of abuse were considered separately, both physical-only abuse and sexual-only abuse were associated with increased risk (though to a lesser degree than combined abuse). And the association was stronger among women whose endometriosis diagnosis was not driven by infertility, suggesting the link may be more pronounced in symptomatic (pain-associated) cases than in infertility-linked diagnoses. 

Study Evaluation :

The study included 60,595 premenopausal women, giving it strong statistical power. Furthermore, by using data from the Nurses’ Health Study II allowed researchers to follow participants over time and reduce recall bias for the outcome (endometriosis). As well as this, endometriosis cases were confirmed by laparoscopy, which is considered the diagnostic gold standard and reduces misclassification. The study also used a detailed “violence victimisation” questionnaire to assess physical and sexual abuse. Additionally, the risk increased with the severity, chronicity, and number of abuse types, strengthening the credibility of the association. The authors had also adjusted for demographic, early-life, and behavioral factors using Cox proportional hazards models. And the analyses were restricted to diagnoses after the abuse questionnaire (2001) produced similar results. The study found the association was stronger for symptomatic cases not driven by infertility, adding nuance to interpretation.

Exposure data were collected retrospectively, which may introduce recall bias or misclassification. Additionally, because the violence questionnaire was issued in 2001 while the diagnoses spanned from 1989 to 2013, some abuse data were collected after the outcome, raising potential concerns of reverse bias. Despite adjustment for multiple variables, unmeasured factors, such as childhood socioeconomic stressors, could still influence the results. Furthermore, participants in the Nurses’ Health Study II were predominantly white and of similar socioeconomic status, which may limit the generalisability of the findings to broader populations.

Even with observed dose–response trends, the observational nature of the study means that the results indicate correlation rather than causation. Finally, women with histories of trauma may be more likely to seek medical care for pelvic pain, which could increase the likelihood of receiving a laparoscopic diagnosis.

Study 2 (Article)

Endometriosis linked to childhood abuse

Fred Hutchinson Cancer Research Center (2018)

Purpose :

The article aims to publicise and explain the findings of a newly published study that links early‑life physical and sexual abuse to a higher risk of Endometriosis. It highlights how this research adds to the growing evidence that adverse childhood experiences beyond the typically acknowledged mental‑health or social effects may also have long-term physical health consequences. The article seeks to raise awareness among the public, health‑care providers, and researchers about this association, and to emphasise that while the association is significant, having endometriosis does not necessarily imply a history of childhood abuse. More broadly, the article aims to frame endometriosis not only as a “gynecological issue” but as a condition potentially influenced by life‑long biopsychosocial factors, reinforcing the need for a holistic approach to understanding and managing it.

Key Findings :

An association between childhood abuse and endometriosis was observed, with women reporting physical or sexual abuse during childhood or adolescence being more likely to develop endometriosis later in life. The risk was particularly elevated among women who experienced severe or multiple types of abuse, indicating a dose–response relationship. The article also highlighted an increased risk for symptomatic cases, as the association was stronger among women with pain-driven endometriosis compared with infertility-driven cases. This suggests that early trauma may influence pain perception or symptom severity.

The literature emphasises that adverse childhood experiences are an important factor in understanding endometriosis, complementing the known biological and hormonal contributors. Finally, the article clearly notes that the findings demonstrate correlation rather than causation: not all women with endometriosis have a history of childhood abuse, and not all women who experience abuse develop endometriosis.

Study Evaluation :

The article communicates complex scientific findings in language accessible to the general public, making research on endometriosis and childhood abuse more understandable. It also highlights important public health implications, emphasising the potential long-term effects of childhood trauma on physical health, as well as mental health. Additionally, the article references a credible, peer-reviewed study, Harris et al. (2018), which lends scientific credibility to its claims. Furthermore, the article raises awareness among healthcare providers and the public about the association between early-life abuse and endometriosis, promoting a holistic approach to patient care. Finally, it acknowledges limitations and nuances, clearly stating that the study demonstrates correlation rather than causation, and that not all individuals with endometriosis have a history of abuse.

However, the article is not a primary research study; it is a secondary source and therefore does not provide original data or statistical analysis. In addition, it does not offer detailed information on sample size, study design, or statistical methods, making it difficult to critically evaluate the research. There is also potential for overgeneralisation: although the article notes caution, readers might misinterpret the association as implying a causal relationship. Finally, the article does not address potential confounders or limitations, such as self-reported abuse or selection bias, which were considered in the original study.

Study 3

Adverse childhood experiences and the risk of endometriosis - a nationwide cohort study

Rostvall et al. (2025)

Purpose :

The primary aim of this study was to investigate whether early-life adversities, broadly defined as a range of adverse childhood experiences (ACEs), including parental substance abuse, parental psychiatric disorder or intellectual disability, teenage parenthood, child welfare intervention, parental separation, residential instability, receipt of public assistance, and exposure to violence, were associated with a higher risk of being diagnosed with endometriosis in adulthood. The study also aimed to examine the relationship between a broad array of register-based indicators of childhood adversity, rather than solely self-reported abuse, and subsequent endometriosis diagnosis. This was achieved through the use of robust national registry data covering virtually all women born in Sweden between 1974 and 2001, thereby mitigating selection bias and enhancing the generalisability of the findings to the wider population.

Research Design / Methodology :

A register-based prospective cohort study of 1,316,946 women born in Sweden between 1974 and 2001, followed until diagnosis, death, emigration, or 31 December 2020. Excluded women who died, emigrated, were adopted, or diagnosed with endometriosis before age 15.

Key Findings :

During follow-ups, 24,311 women (1.9% of the cohort) received an endometriosis diagnosis. They also found that experiencing any adversity in childhood was associated with a 20% higher risk of endometriosis diagnosis compared to no adversity.  Furthermore, the risk increased with the number of different adversities. Women who experienced five or more adversities had up to a 60% increased risk. Among specific adversities, the strongest association was for exposure to violence where the weakest, but still statistically significant, was having a teenage parent

Study Evaluation :

The study utilised a very large, population-based sample, including approximately 1.316 million women born in Sweden between 1974 and 2001. This sample size provides strong statistical power and reduces the likelihood that the findings are due to chance or small-sample variability. It also enhances generalisability within the studied population, as the study was not limited to a small, clinical, or convenience sample.

A prospective, register-based design was employed rather than relying on retrospective self-report, meaning that childhood adversities (ACEs) and endometriosis diagnoses were derived from national registers rather than participants’ recall. This approach minimises recall bias, which is a common issue in studies depending on self-reported childhood trauma. It also allows for objective, physician-coded diagnoses of endometriosis, improving reliability compared with self-report alone.

The study comprehensively covered a wide range of childhood adversities, including parental substance abuse, parental psychiatric disorder, parental intellectual disability, teenage parenthood, child welfare intervention, parental separation, residential instability, receipt of public assistance, and exposure to violence, including parental exposure to violence. This breadth enabled the authors to examine whether different forms of adversity, not only abuse but also socioeconomic and family-instability factors, are associated with the risk of developing endometriosis.

Despite these strengths, the study has several limitations. Endometriosis is widely underdiagnosed, and if many women in the cohort had undiagnosed endometriosis, they would have been misclassified as “non-cases,” potentially biasing the results. If underdiagnosis is random (non-differential), it may dilute associations; however, if it varies by exposure to ACEs, it could bias associations unpredictably.

Another limitation is the relatively young age of the cohort, with an average age of approximately 32 years at the end of follow-up. Since endometriosis can be diagnosed later in life, some women may not yet have received a diagnosis, meaning lifetime risk may be underestimated and associations with ACEs may evolve with age.

Finally, the generalisability of the findings is limited. The study population comprised Swedish-born women, so the results may not apply to populations with different demographics, healthcare systems, socioeconomic structures, or ethnic backgrounds. Cultural and systemic differences in diagnostic rates, healthcare access, social support, and reporting of adversity may all influence generalisability.

Overview and comparison of literature :

The association between childhood adversity and endometriosis has been examined in multiple studies, including Harris et al. (2018), the Fred Hutchinson Cancer Research Center (2018) summary, and Rostvall et al. (2025). Harris et al. conducted a prospective cohort study using data from the Nurses’ Health Study II, which included over 60,000 premenopausal women. The study found that self-reported childhood physical or sexual abuse was associated with a significantly increased risk of laparoscopically confirmed endometriosis. A dose–response relationship was also observed, whereby greater severity, chronicity, or multiplicity of abuse types corresponded to higher risk.

The Fred Hutchinson article summarised these findings for a public audience, emphasising the dose–response trend, the potential long-term biological consequences of early trauma, and the importance of recognising psychosocial factors alongside biological contributors to endometriosis. The article also clearly noted that causation could not be inferred from the study.

Rostvall et al. (2025) expanded on this research using a nationwide Swedish cohort of over 1.3 million women, examining a broader spectrum of adverse childhood experiences (ACEs), including parental mental illness, substance abuse, family instability, and exposure to violence. By using registry-based diagnoses rather than self-report, this study found that nearly all categories of childhood adversity were associated with a higher risk of endometriosis, with risk increasing cumulatively with the number of adversities experienced. Rostvall et al.’s study addressed limitations of self-report bias and limited generalisability present in the 2018 study and provided stronger evidence of a graded relationship between childhood adversity and endometriosis risk across a population-based sample.

Comparing these three sources highlights several key points. Both the Harris et al. and Rostvall et al. studies provide consistent evidence that early-life adversity is associated with increased endometriosis risk, although the types of adversity examined differ. Harris et al. focused narrowly on physical and sexual abuse, while Rostvall et al. incorporated a broader spectrum of ACEs, reflecting cumulative psychosocial stress. The Fred Hutchinson summary communicates the Harris et al. findings to a broader audience but does not provide new data.

Across all studies, limitations include their observational design, potential residual confounding, and the inability to establish causation. Nevertheless, collectively, these studies support a biopsychosocial model, in which early-life adversity may act as a risk modifier for endometriosis. Biological pathways potentially involved include stress-response dysregulation, immune dysfunction, and altered pain processing. These findings highlight the need for continued research into underlying mechanisms and the development of preventive strategies.

Conclusion :

The current body of evidence suggests a notable association between adverse childhood experiences (ACEs) and the development of endometriosis, as well as the severity of symptoms experienced later in life. Large-scale, population-based studies, including the Swedish nationwide cohort, indicate a cumulative effect, whereby exposure to multiple childhood adversities corresponds with higher rates of endometriosis diagnosis. These findings support a biopsychosocial framework, in which early-life stress may interact with biological predispositions, immune function, and pain processing to influence both disease susceptibility and symptom expression.

It is essential to emphasise that existing research demonstrates correlation rather than causation. Methodological limitations, such as the potential for underdiagnosis, reliance on proxy measures of adversity, and confounding due to patterns of healthcare utilisation, mean that ACEs should be considered one of multiple factors potentially associated with endometriosis rather than a direct causal agent.

Understanding the relationship between childhood trauma and endometriosis highlights the critical importance of incorporating psychological and social dimensions into gynaecological care. By acknowledging these factors, clinicians can adopt a more holistic approach to diagnosis, management, and patient support. Future research should prioritise longitudinal designs, investigate underlying mechanistic pathways, and include diverse populations to further elucidate the nature of this association. Such work will be essential for informing prevention strategies, refining treatment approaches, and ultimately improving outcomes for individuals living with endometriosis.

DISCLAIMER : I’m sharing this for awareness and inspiration - not as medical guidance. I’m not a medical professional or student, so please speak to a qualified healthcare provider for advice about your personal health.

Thank you

References :

 

  • Harris, H.R., Wieser, F., Vitonis, A.F., Rich-Edwards, J., Boynton-Jarrett, R., Bertone-Johnson, E.R. and Missmer, S.A. (2018). Early life abuse and risk of endometriosis. Human Reproduction, 33(9), pp.1657–1668. doi:https://doi.org/10.1093/humrep/dey248.
  • Fred Hutch. (2018). Endometriosis linked to childhood abuse. [online] Available at: https://www.fredhutch.org/en/news/center-news/2018/07/endometriosis-linked-to-childhood-abuse.html.
  • Rostvall, M., Magnusson, C., Gemzell-Danielsson, K., Kosidou, K. and Sieurin, J. (2025). Adverse childhood experiences and the risk of endometriosis—a nationwide cohort study. Human Reproduction. [online] doi:https://doi.org/10.1093/humrep/deaf101.

Extra findings :

(disproportionality towards black women)

DISCLAIMER : I’m sharing this for awareness and inspiration - not as medical guidance. I’m not a medical professional or student, so please speak to a qualified healthcare provider for advice about your personal health. Thank you