Endometriosis is a condition that occurs when uterine tissue grows where it shouldn’t and adheres to ovaries, fallopian tubes, or abdominal tissue. It may cause a great deal of pain — or none at all. No one knows what causes the condition or the difference in discomfort, but a 2018 study shows that women who experienced childhood abuse are not only more likely to have endometriosis, but also more likely to feel pain than those who have not been abused.
Three main findings on endometriosis and abuse
The association between endometriosis and abuse is not a small one. Holly Harris, M.D., an epidemiologist at Fred Hutchinson Cancer Center and the lead researcher on this study, collected data from the 60,595 women in the Nurses’ Health Study II and found 3,000 cases of endometriosis. Dr. Harris found that women who reported severe or chronic childhood abuse were 79 percent more likely to have endometriosis (confirmed through laparoscopic surgery).
In a phone interview with HealthCentral, Dr. Harris highlighted three important takeaways from this research:
- First, moderate to severe childhood abuse is too common – reported by 34 percent of women.
- Second, there is a clear association between early life abuse and risk of endometriosis. Dr. Harris also wants to be clear that this does not mean that all women with endometriosis were abused.
- Third, this study adds more data to the growing body of evidence that links childhood adverse experiences with health outcomes.
This body of evidence that Dr. Harris refers to shows associations between abuse and uterine fibroids, between abuse and hypertension, and between endometriosis and hypertension. Looking for the connection between endometriosis and abuse was the next logical step and motivated Dr. Harris to pursue the project.
How abuse severity relates to pain levels
Not only did the study find a correlation between abuse and endometriosis, but it found further association between the amount and severity of abuse and the likelihood the endometrial lesions caused pain. For these women, the condition was diagnosed because their pain was bad enough to seek medical help. Many others, who do not have pain, are diagnosed as a result of fertility problems or other complications.
But why does this association between endometrial pain and abuse exist?
“That’s a good question that our study wasn’t really designed to untangle,” Dr. Harris says. “But we know that abuse is associated with the impaired functioning of the hypothalamic-pituitary-adrenal axis [the interaction between three glands in the body], so if this axis is altered in its functioning, that can lead to a high sensitivity to stress and pain. It could be that there’s a stress response to the trauma of abuse that causes women to be more sensitive to pain that comes from endometriosis lesions.”
However, Dr. Harris says, she wants to be clear that the researchers “have not, in any way, said the pain is in the woman’s head. The pain is coming from the lesions. It’s a physiologic response that’s driven by the stress and trauma of abuse.”
To capitalize on this body of research showing a link between childhood abuse and health, Dr. Harris says researchers need to develop a better understanding of the underlying biology of this pain pathway and how trauma leads to changes in physical health.
How do we use this research to improve women’s health?
Helen L. Coons, Ph.D., a clinical health psychologist who specializes in women’s health at Women’s Mental Health Associates in Philadelphia, agrees that identifying the pathway of how abuse changes the body is important.
“There’s reason to think that individuals who have had adverse childhood events have different stress responses,” Dr. Coons said in a phone interview with HealthCentral. “They grow up with a different immunologic profile, and that’s not unrelated to endometriosis. Can I tell you the exact pathway? I don’t know if anybody can, but it’s an interesting question.”
Furthermore, Coons is interested in why some children are more resilient to abuse and what makes them have more symptoms as they grow. If we understand the mechanism and the pathway that causes the health problem, maybe we can minimize the impact.
“Maybe we can know how to intervene when there’s an adverse childhood event so that resilient children are even more so and grow up to be resilient adults who are less at risk for the kinds of medical problems that are on the list,” Coons says. “When is the intervention necessary for prevention? And, are we able, through interventions, to change the stress response?”
For now, we know that the abuse women and girls face has far-reaching effects that can last a lifetime. The next question: What is the path forward? When we know that, perhaps we can find a way to prevent these outcomes and help reduce the pain that many women face due to endometriosis.