Abstract

Background: Endometriosis is a chronic inflammatory condition affecting nearly 10% of women of reproductive age worldwide. Increasingly recognised as a biopsychosocial disorder, it is associated with substantial mental health consequences. Chronic pelvic pain, infertility, diagnostic delays, and social stigma contribute to higher levels of depression, anxiety, and reduced quality of life, yet the psychological dimensions remain insufficiently addressed. This review synthesises current evidence on the mental health impact of endometriosis and examines holistic approaches for improving patient outcomes. Methods: A pragmatic narrative review was conducted using a systematic search of PubMed/MEDLINE, PsycINFO, Scopus, Web of Science, Embase, and Google Scholar (January–February 2026). Search terms combined “endometriosis” with terms for psychological outcomes (“mental health”, “depression”, “anxiety”, “quality of life”, “psychological distress”) and interventions (“holistic management”, “psychosocial interventions”, “integrative strategies”, “multidisciplinary care”). Inclusion criteria encompassed peer-reviewed articles, systematic reviews, etaanalyses, and guidelines from 2000 onwards in English; exclusion criteria eliminated case reports and non-relevant animal studies. Supplementary hand-searching of reference lists, forward citation tracking, and inclusion of grey literature (e.g., WHO, ESHRE documents) enhanced comprehensiveness. Approximately 1,245 records were screened, 287 full texts reviewed, and 65 references incorporated. Results: Women with endometriosis exhibit significantly higher prevalence of depression (20–60%) and anxiety (30–50%) compared with controls, with pooled odds ratios of 2.5–3.5. Chronic pelvic pain, central sensitisation, pro- inflammatory cytokines (IL-6, TNF-α), and oestrogen-progesterone imbalance drive neurobiological vulnerability, while pain catastrophising, fear-avoidance, diagnostic delays (7–11 years), medical gaslighting, infertility grief, and social stigma amplify psychological burden. Health-related quality of life is markedly impaired across physical, emotional, social, and occupational domains. Holistic strategies integrating hormonal/surgical treatment with CBT, mindfulness-based stress reduction, acceptance and commitment therapy, anti-inflammatory diets, yoga/Pilates, acupuncture, peer support, and digital tools demonstrate moderate to strong evidence for reducing depressive symptoms, pain perception, and emotional distress while improving functioning and self-efficacy. Conclusion: Endometriosis should be addressed as a biopsychosocial condition requiring multidisciplinary, patient-centred care. Integrating psychological support within routine management may significantly enhance quality of life and overall wellbeing. Key Message: Endometriosis extends beyond a gynaecological disorder to a complex biopsychosocial condition with significant mental health consequences. Integrating psychological care with medical management can reduce pain-related distress, improve quality of life, and address stigma. Multidisciplinary, patient-centred approaches are essential to ensure comprehensive, compassionate care for women affected by endometriosis.

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