Archives of Women's Mental Health

, Volume 22, Issue 6, pp 723–735 | Cite as

Psychological interventions for endometriosis-related symptoms: a systematic review with narrative data synthesis

  • Leesa Van NiekerkEmail author
  • Bronwyn Weaver-Pirie
  • Mandy Matthewson
Review Article


Endometriosis impacts the physical, psychological and quality of life domains of women. Despite the medical and/or surgical management of endometriosis, the presence of persistent pelvic pain and psychological distress often continues, suggesting a role for psychological interventions in treatment planning. The present study aimed to conduct the first systematic review, with narrative data synthesis, on psychological interventions for endometriosis-related symptoms. The study also aimed to determine the effectiveness of current interventions in resolving psychological and pain-related loss of function associated with endometriosis and to identify gaps in the literature requiring further research. A total of 15,816 studies were retrieved through database searching and handsearching, with two researchers identifying 11 full-text studies that met inclusion criteria. Three studies of ‘moderate’ quality were identified, although the overall quality of studies was found to be ‘weak’, with a ‘high’ risk of bias. The findings regarding the effectiveness of psychological interventions for endometriosis-related symptoms remain inconclusive. Further research into psychological interventions for women with endometriosis that employ evidence-based protocols with high intervention integrity is recommended.


Endometriosis Psychological intervention Persistent pelvic pain Quality of life 



  1. Allaire C, Williams C, Bodmer-Roy S, Zhu S, Arion K, Ambacher K, Yong PJ (2018) Chronic pelvic pain in an interdisciplinary setting: 1-year prospective cohort. Am J Obstet Gynecol 218(1):114.e1–114.e12CrossRefGoogle Scholar
  2. Bawa FL, Mercer SW, Atherton RJ, CLague F, Keen A, Scott NW, Bond CM (2015) Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. Br J Gen Pract 65(635):e387–e400PubMedPubMedCentralCrossRefGoogle Scholar
  3. Beissner F, Preibisch C, Schweizer-Arau A, Popovici RM, Meissner K (2017) Psychotherapy with somatosensory stimulation for endometriosis-associated pain: the role of the anterior hippocampus. Biol Psychiatry 17:30038Google Scholar
  4. Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M (2015) Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update 21(1):136–152PubMedCrossRefPubMedCentralGoogle Scholar
  5. Cano-García FJ, González-Ortega MD, Sanduvete-Chaves S, Chacón-Moscoso S, Moreno-Borrego R (2017) Evaluation of a psychological intervention for patients with chronic pain in primary care. Front Psychol 8:435PubMedPubMedCentralCrossRefGoogle Scholar
  6. Carey ET, Martin CE, Siedhoff MT, Bair ED, As-Sanie S (2014) Biopsychosocial correlates of persistent postsurgical pain in women with endometriosis. Int J Gynecol Obstet 124(2):169–173CrossRefGoogle Scholar
  7. Chaman-Ara K, Bahrami MA, Bahrami E (2017) Endometriosis psychological aspects: a literature review. JEPPD 9(2):105–111Google Scholar
  8. Chiantera V, Abesadze E, Mechsner S (2017) How to understand the complexity of endometriosis-related pain. JEPPD 9(1):30–38Google Scholar
  9. Cochrane Public Health (n.d.) Quality Assessment Tool for Quantitative Studies. In: Unit 8: principles of critical appraisal [pdf]Google Scholar
  10. Colwell CM (1997) Music as distraction and relaxation to reduce chronic pain and narcotic ingestion: a case study. Music Ther Perspect 15(1):24–31CrossRefGoogle Scholar
  11. Cox H, Ski CF, Wood R, Sheahan M (2003) Endometriosis, an unknown entity: the consumer’s perspective. Int J Consum Stud 27(3):200–209Google Scholar
  12. Culley L, Law C, Hudson N, Denny E, Michell H, Baumgarten M, Raine-Fenning N (2013) The social and psychological impact of endometriosis on women’s lives: a critical narrative review. Hum Reprod Update 19(6):625–639PubMedCrossRefPubMedCentralGoogle Scholar
  13. Daniels JP, Khan KS (2010) Chronic pelvic pain in women. Br Med J 341(4834):772–775Google Scholar
  14. Denny E (2004) Women’s experience of endometriosis. J Adv Nurs 46(6):641–648PubMedCrossRefPubMedCentralGoogle Scholar
  15. Denny E (2009) I never know from one day to another how I will feel:pain and uncertainty in women with endometriosis. Qual Health Res 19(7):985–995PubMedCrossRefPubMedCentralGoogle Scholar
  16. Donker T, Griffiths KM, Cuijpers P, Christensen H (2009) Psychoeducation for depression, anxiety and psychological distress: a meta-analysis. BMC Med 7(79)Google Scholar
  17. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, Dhooghe T, Bie BD, Nelen W (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod 29(3):400–412PubMedCrossRefPubMedCentralGoogle Scholar
  18. Gatchel RJ (2004) Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. Am Psychol 59(8):795–805PubMedCrossRefPubMedCentralGoogle Scholar
  19. Gay MC, Philippot P, Luminet O (2002) Differential effectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erikson. Eur J Pain 6(1):1–16PubMedCrossRefPubMedCentralGoogle Scholar
  20. Gilmour JA, Huntington A, Wilson HV (2008) The impact of endometriosis on work and social participation. Int J Nurs Pract 14(6):443–448PubMedCrossRefPubMedCentralGoogle Scholar
  21. Glombiewski JA, Sawyer AT, Gutermann J, Koenig K, Rief W, Hofmann SG (2010) Psychological treatments for fibromyalgia: a meta-analysis. Pain 151(2):280–295PubMedCrossRefPubMedCentralGoogle Scholar
  22. Gonçalves AV, Barros NF, Bahamondes L (2017) The practice of hatha yoga for the treatment of pain associated with endometriosis. J Altern Complement Med 23(1):45–52PubMedCrossRefPubMedCentralGoogle Scholar
  23. Hansen KE, Kesmodel US, Kold M, Forman A (2016) Long-term effects of mindfulness-based psychological intervention for coping with pain in endometriosis: a six-year follow-up on a pilot study. Nord Psychol 69(2):100–109CrossRefGoogle Scholar
  24. Hawkins RS, Hart AD (2003) The use of thermal biofeedback in the treatment of pain associated with endometriosis: preliminary findings. Appl Psychophysiol Biofeedback 28(4):279–289PubMedCrossRefPubMedCentralGoogle Scholar
  25. Higgins JPT, & Green S (2011) (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane collaborationGoogle Scholar
  26. Huntington A, Gilmour JA (2005) A life shaped by pain: women and endometriosis. J Clin Nurs 14(9):1124–1132PubMedCrossRefPubMedCentralGoogle Scholar
  27. Jia SZ, Leng JH, Shi JH, Sun PR, Lang JH (2012) Health-related quality of life in women with endometriosis: a systematic review. J Ovarian Res 5(1):29PubMedPubMedCentralCrossRefGoogle Scholar
  28. Jones G, Jenkinson C, Kennedy S (2004) The impact of endometriosis upon quality of life: a qualitative analysis. J Psychosom Obstet Gynaecol 25(2):123–133PubMedCrossRefPubMedCentralGoogle Scholar
  29. Kold M, Hansen T, Vedsted-Hansen H, Forman A (2012) Mindfulness-based psychological intervention for coping with pain in endometriosis. Nord Psychol 64(1):2–16CrossRefGoogle Scholar
  30. Lehman BJ, David DM, Gruber JA (2017) Rethinking the biopsychosocial model of health: understanding health as a dynamic system. Soc Personal Psychol Compass 11:e12328CrossRefGoogle Scholar
  31. Leyland N, Casper R, Laberge P, Singh SS, SOGC Clinical Practice Gynaecology Committee (2010) Endometriosis: diagnosis and management. SOGC clinical practice guideline no. 244, July 2010. J Obstet Gynaecol Can 32(7, Supplement 2):S1–S33PubMedCrossRefPubMedCentralGoogle Scholar
  32. Lorençatto C, Petta C, Navarro M, Bahamondes L, Matos A (2006) Depression inwomen with endometriosis with and without chronic pelvic pain. Acta Obstet Gynecol 85(1):88–92CrossRefGoogle Scholar
  33. Lorençatto C, Vieira MJ, Marques A, Benetti-Pinto CL, Petta CA (2007) Evaluation of pain and depression in women with endometriosis after a multi-professional group intervention. Rev Assoc Med Bras 53(5):433–438PubMedCrossRefPubMedCentralGoogle Scholar
  34. McCracken LM, Vowles KE (2004) Acceptance and commitment therapy and mindfulness for chronic pain: model, process and progress. Am Psychol 69(2):178–187CrossRefGoogle Scholar
  35. McCracken LM, Carson JW, Eccleston C, Keefe FJ (2004) Acceptance and change in the context of chronic pain. Pain 109(1–2):4–7PubMedCrossRefPubMedCentralGoogle Scholar
  36. Meissner K, Böhling B, Schweizer-Arau A (2010) Long-term effects of traditional Chinese medicine and hypnotherapy in patients with severe endometriosis—a retrospective evaluation. Res Complement Med J 17(6):314–320CrossRefGoogle Scholar
  37. Meissner K, Schweizer-Arau A, Limmer A, Preibisch C, Popovici RM, Lange I, de Oriol B, Beissner F (2016) Psychotherapy with somatosensory stimulation for endometriosis-associated pain: a randomized controlled trial. Obstet Gynaecol 128(5):1134–1142CrossRefGoogle Scholar
  38. Nnoaham KE, Hummelshoj L, Webster P, D’Hooghe T, Nardone FD, Nardone CD, Zondervan KT (2011) Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 96(2):366–373.e8PubMedPubMedCentralCrossRefGoogle Scholar
  39. Perrott K (2018) Endometriosis research allocated $2.5 million in government funding. ABC NewsGoogle Scholar
  40. Petrelluzzi KF, Garcia MC, Petta CA, Grassi-Kassisse DM, Spadari- Bratfisch RC (2008) Salivary cortisol concentrations, stress and quality of life in women with endometriosis and chronic pelvic pain. Stress 11(5):390–397PubMedCrossRefPubMedCentralGoogle Scholar
  41. Petrelluzzi K, Garcia MC, Petta CA, Ribeiro DA, de Oliveira Monteiro NR, Cespedes IC, Spadari RC (2012) Physical therapy and psychological intervention normalize cortisol levels and improve vitality in women with endometriosis. J Obstet Gynaecol 33(4):191–198Google Scholar
  42. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N, Roen K, Duffy S (2006) Guidance on the conduct of narrative synthesis in systematic reviews. Final report, Institute of Health Research. ESRC Methods Programme, LancasterGoogle Scholar
  43. Prentice A (2001) Endometriosis. Br Med J 323(7304):93–95CrossRefGoogle Scholar
  44. Riazi H, Tehrania N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A (2014) Patients’ and physicians’ descriptions of occurrence and diagnosis of endometriosis: a qualitative study form Iran. BMC Womens Health 14:103PubMedPubMedCentralCrossRefGoogle Scholar
  45. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart L, the PRISMA-P Group (2015) Preferred reporting items for systematic review and meta-analyses protocols (PRISMA-P) 2015: elaboration and explanation. Br Med J 349:g7647CrossRefGoogle Scholar
  46. Tripoli TM, Sato H, Sartori MG, de Araujo FF, Girão MJ, Schor E (2011) Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis. J Sex Med 8(2):497–503PubMedCrossRefPubMedCentralGoogle Scholar
  47. Vigano P, Parazzini F, Somigliana E, Vercellini P (2004) Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 182(2):177–200CrossRefGoogle Scholar
  48. Wade RH (2004) Is globalization reducing poverty and inequality? Int J Health Serv 34(3):381–414PubMedCrossRefPubMedCentralGoogle Scholar
  49. Wee-Stekly WW, Kew CCY, Chern BSM (2015) Endometriosis: a review of the diagnosis and pain management. Gynaecol Minim Invasive Ther 4(4):106–109CrossRefGoogle Scholar
  50. Weijenborg PTM, Ter Kuile MM, Stones W (2009) A cognitive behavioural assessment of women with chronic pelvic pain. J Psychosom Obstet Gynaecol 30(4):262–268PubMedCrossRefPubMedCentralGoogle Scholar
  51. Williams AC, Eccleston C, Morley S (2012) Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 14(11):CD007407Google Scholar
  52. Wilson DB (n.d.) Practical meta-analysis effect size calculator [Online calculator]Google Scholar
  53. Young K, Fisher J, Kirkman M (2015) Women's experiences of endometriosis: a systematic review and synthesis of qualitative research. J Fam Plann Reprod Health Care 41(3):225–234PubMedCrossRefPubMedCentralGoogle Scholar
  54. Zhao L, Wu H, Zhou X, Wang Q, Zhu W, Chen J (2012) Effects of progressive muscular relaxation training on anxiety, depression and quality of life of endometriosis patients under gonadotrophin-releasing hormone agonist therapy. Eur J Obstet Gynaecol Reprod Biol 162(2):211–215CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Leesa Van Niekerk
    • 1
    Email author
  • Bronwyn Weaver-Pirie
    • 1
  • Mandy Matthewson
    • 1
  1. 1.College of Health and Medicine, Division of PsychologyUniversity of TasmaniaHobartAustralia

Personalised recommendations