Systemic Inflammation and Psychological Trauma in Endometriosis: A Narrative Review Towards Integrated Management
DOI:
https://doi.org/10.59493/advpbl/2026.1.7Keywords:
Chronic pelvic pain, Endometriosis, Immune dysregulation, Multidisciplinary pain management, Pro-inflammatory cytokines, Trauma-informed careAbstract
Endometriosis is increasingly recognized as a systemic inflammatory disease with complex immune and neuroendocrine dysregulation. This narrative review synthesized evidence on the bidirectional relationship between systemic inflammation and psychiatric comorbidities, drawing from 32 peer-reviewed studies (2020–2026). Results indicate that endometriotic lesions release interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α) into systemic circulation, driving chronic immune activation and Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation. This leads to significant (p < 0.05) alteration of cortisol secretion, neuroinflammation, and structural changes in the hippocampus and amygdala, which in turn perpetuate hyperalgesia, fatigue, and heightened vulnerability to depression and anxiety. Conversely, psychological trauma and diagnostic delays exacerbate inflammatory profiles, forming a self-perpetuating cycle. To break this neuro-immune cycle, clinicians must transition from isolated surgical management to integrated, multidisciplinary care. This requires operationalizing trauma-informed practices through routine Adverse Childhood Experiences (ACE) screening, validated pelvic pain psychological distress tools, and explicit referral pathways to specialized psychiatric support and pelvic-floor physical therapy. Future research must address a critical gap in the literature by identifying the precise dose-response thresholds linking specific circulating cytokines to localized psychiatric symptom severity; these key gaps regarding optimal screening tools and intervention timing warrant future prospective studies.
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