Childhood trauma linked to higher risk of endometriosis in adult women
1 of 2 | Endometriosis affects one in 10 women in the United States and can cause chronic and frequently severe pelvic pain. A new study has found that women who experienced childhood traumas are at heightened risk to develop the condition as adults. Photo by cottonbro studio/Pexels
A suspected link between childhood trauma and the risk of developing endometriosis in later life was strengthened Wednesday with the publication of study that showed a greater chance of the condition among women with histories of difficult childhoods.
The study of hundreds of thousands of women in Sweden found those who as children experienced substance abuse, had a teenage or mentally ill parent, financial problems or a death in the family were linked to a 20% increased risk of an endometriosis diagnosis compared to women who had not been exposed.
However, the risk was much greater for girls exposed more than one of those factors, rising to 60%, while those who witnessed or were subjected to violence saw more than twice the risk of developing endometriosis later in life compared to women who had not been exposed, the Swedish authors reported.
The study published in the British medical journal Human Reproduction builds on earlier findings that women who experienced physical and sexual abuse as children had a 79% higher risk of developing the painful condition, which affects one in 10 reproductive-age women in the United States.
Lead author Dr. Marika Rostvall, a physician and doctoral student in the Department of Global Public Health at the Karolinska Institute in Stockholm, told UPI the findings provide more evidence of the strong connection between mental and physical health.
The findings “support previous studies in other areas of medicine suggesting that the mind and body are intimately connected and that psychologically taxing events can have biological consequences,” she said in emailed comments.
Endometriosis usually affects women in their 20s and 30s, and while there are a handful known risk factors such as starting menstruation early and having a lean body type, the cause remains unknown.
The problems stem from the behavior of tissues known as endometrium, which under normal circumstances are found only in the inner lining of a woman’s uterus. Those tissues grow to a thick, blood vessel-rich layer during the menstrual cycle to prepare for possible implantation of an embryo, and then shed the blood at the end of the cycle if there is no embryo present.
But in some cases, endometrium behave abnormally and start growing outside of the uterus. When they do so, they can attach themselves to the ovaries, fallopian tubes, bowel, bladder or other parts of the body, triggering frequently severe pelvic pain as they carry out their monthly thickening function.
As a result, endometriosis can cause excessive bleeding and even infertility — which is the case for up to half of women with the condition — as well as cysts, scar tissue and adhesions. Those in turn can trigger chronic pain, including during with sexual intercourse as well as during urination or bowel movements.
The Swedish researchers began by looking at the health records of more 1.3 million women born in in the country between 1974 and 2001, eventually narrowing it down to 24,000 who were diagnosed with endometriosis.
They then tapped several national registers to track their childhood experiences, looking for evidence of trauma or difficulties, including crimes such as violence and sexual abuse. The results, they said, demonstrate the importance of considering “the whole person” not just the symptoms of endometriosis.
The negative physical consequences of psychological trauma can perhaps be traced to a compromised ability of the immune system to protect against the condition, or even in how the body perceives pain, Rostvall said.
“I think the immune system is an interesting part of the puzzle when it comes to trying to understand why some women develop endometriosis,” she said. “Chronic inflammation is a big part of the disease, and it has also been shown that women with endometriosis have a higher incidence of autoimmune disorders compared to healthy women.
“There is a lot of interesting research being done in the area, and a deeper understanding of exactly how the immune system functions in relation to endometriosis could potentially help bring forward new kinds of treatment.”
Like some other women’s health issues, the pain of endometriosis is often dismissed and sufferers have reported negative experiences with healthcare professionals, often in the form of providers “trivializing” symptoms, which can cause feelings of loneliness and alienation.
This, in turn, can make obtaining a diagnosis difficult and prompt some to choose to avoid engaging with doctors altogether.
A British psychological-based study from last year showed some women who suffered symptoms felt they had experienced a form of “medical gaslighting” in which they were made to doubt their own perceptions of pain.
Rostvall said these kinds of experiences are especially relevant when the patients are women who come from socially and psychologically traumatic backgrounds.
“A lot of women presenting with pain, especially socioeconomically disadvantaged women and women with psychiatric comorbidities, who are more likely to have experienced childhood adversity, have their pain dismissed. They then have to wait for a long time to receive a diagnosis and treatment, potentially allowing the condition to worsen,” she said.
“I think physicians should be aware of the complex linkage between the mind and body in general and be more open to listening to their patients’ stories, take their pain seriously, and offer a thorough physical examination.”