Endometriosis, Psychiatric Disorders May Raise the Risk of One Another

Women who have endometriosis have a higher risk of mental illnesses such as depression, anxiety, and substance use disorders (SUDs), suggests a study in the American Journal of Obstetrics and Gynecology. The study also revealed that the opposite may be true: Women who have depression, anxiety, or other mental illnesses may have a higher risk of endometriosis. Endometriosis is an often painful condition that occurs when tissue similar to the lining of the uterus, called the endometrium, grows in other places, such as the fallopian tubes and ovaries.

Menghan Gao, M.Sc., of the Karolinksa Institute in Stockholm and colleagues analyzed data from several Swedish registers to follow all women who were born in Sweden between 1973 and 1990 and who were diagnosed with psychiatric disorders and endometriosis between age 14 years and the year 2016. They found that women with a previous diagnosis of endometriosis had higher rates of bipolar disorder, depressive disorders, anxiety and stress-related disorders, eating disorders, SUDs, personality disorders, and attention-deficit/hyperactivity disorder (ADHD) compared with women who did not have endometriosis. The greatest risk appeared to be for SUDs and depressive disorders: Women with endometriosis had nearly twice the rate of these conditions than their peers without endometriosis.

Women with a history of psychiatric disorders were more likely than those without a such a history to be later diagnosed with endometriosis. Those with anxiety and stress-related disorders had nearly twice the rate of endometriosis as those without these disorders. Those with a history of personality disorders, ADHD, or depressive disorders were also more likely to have endometriosis than those without such a history.

Abnormalities in the immune system may partly explain the relationship between psychiatric disorders and endometriosis, the researchers wrote. “It is believed that immune dysfunctions followed by inflammatory response to the [endometriosis] lesions are key factors in the pathogenesis of endometriosis, and mounting evidence implicates immune dysregulation in the causation of psychiatric disorders,” they wrote.

The researchers added that the psychological and physical suffering caused by endometriosis could amplify mental distress and that medications used to treat endometriosis may influence mental health. They also stated that women with psychiatric disorders are already receiving health care services, which may increase detection of endometriosis, and that undiagnosed symptoms of endometriosis, such as pain that causes psychological distress, may be misdiagnosed as psychiatric disorders.

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Hysterectomy Associated With Increased Risk of Bipolar Disorder, Study Suggests

Women who receive a hysterectomy are more than twice as likely to develop bipolar disorder as women who do not undergo this procedure, according to a study published in Depression and Anxiety. This risk of bipolar following hysterectomy is even greater for women who had endometriosis or were taking Premarin (a form of estrogen therapy) at the time of surgery.

“To our knowledge, this is the first study to longitudinally evaluate [the incidence of] bipolar disorder in a national sample of women who have undergone a hysterectomy,” wrote Yu‐Chih Shen, M.D., Ph.D., of Taiwan’s Tzu Chi University and colleagues. “The knowledge of how surgical or natural hormonal withdrawal influences mood is fundamental and emphasizes the importance of coordinated psychiatric and gynecological care.”

Shen and colleagues analyzed health record data from 4,337 women aged 30 to 50 in Taiwan who underwent a hysterectomy between 2000 and 2013 along with 17,348 age-matched women who did not have this procedure. During a roughly eight year follow-up period, 20 women who underwent a hysterectomy and 28 who did not developed bipolar disorder. Nineteen of the 20 bipolar diagnoses in the hysterectomy group occurred more than one year after the surgery.

The researchers found that women who underwent a hysterectomy were more than twice as likely to subsequently develop bipolar disorder. This risk was raised to more than three times as likely among women who had endometriosis at the time of their surgery (the presence of endometriosis also resulted in a slightly elevated risk of bipolar disorder among women who did not have a hysterectomy). Women who were taking Premarin at the time of hysterectomy also had more than three times the risk of developing bipolar disorder. There was no elevated risk among women taking estradiol, another type of estrogen therapy, at the time of their hysterectomy, nor was there any elevated risk of bipolar disorder among women taking Premarin who did not have a hysterectomy.

For related information, see the Psychiatric News article “Early Surgical Menopause Found to Have MH Effects.”

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