Archives of Women's Mental Health

, Volume 21, Issue 1, pp 1–13 | Cite as

Behavioral, cognitive, and emotional coping strategies of women with endometriosis: a critical narrative review

  • Cristina ZarboEmail author
  • Agostino Brugnera
  • Luigi Frigerio
  • Chiara Malandrino
  • Massimo Rabboni
  • Emi Bondi
  • Angelo Compare
Review Article


Endometriosis is a disabling and long-term medical condition affecting quality of life and mental health. Behavioral, cognitive, and emotional coping strategies, emotional intelligence, and metacognition could in part explain the link between the disease and impaired psychological and life functioning. This critical narrative review aimed at examining the state of the art of the relationships between endometriosis and these factors. According to PRISMA principles, we performed a systematic search for quantitative and qualitative studies on multiple electronic databases as regards coping strategies, emotional intelligence, and metacognition in women with endometriosis. Studies were subjected to interpretative and critical narrative synthesis. A total of 9 papers were included in the review. Three main categories were identified in thematic analysis and resumed in the manuscript. Findings suggested that (a) pain is considered the major stressor; (b) they usually use both adaptive and maladaptive coping strategies; (c) women with endometriosis and related chronic pain seem to repress emotions more likely than healthy ones; (d) suppressing own emotions, pain catastrophizing, and having a passive coping style are related to higher self-reported pain; and (e) emotional and avoidance coping styles are associated to poor mental status, while positive coping strategies focusing on the problem or on emotions, detached and rational styles are associated to better mental health. Few studies with mixed results and some methodological flaws have focused on coping strategies in women with endometriosis. No studies focusing on metacognition or emotional intelligence were found. Methodological biases, suggestions for future research, and implications for clinical practice were discussed.


Endometriosis Coping Emotional intelligence Metacognition Review 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Buer N, Linton SJ (2002) Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population. Pain 99:485–491CrossRefPubMedGoogle Scholar
  2. Butow P, Kelly S, Thewes B, Hruby G, Sharpe L, Beith J (2015) Attentional bias and metacognitions in cancer survivors with high fear of cancer recurrence. Psychooncology 24:416–423. CrossRefPubMedGoogle Scholar
  3. Carey ET, Martin CE, Siedhoff MT, Bair ED, As-Sanie S (2014) Biopsychosocial correlates of persistent postsurgical pain in women with endometriosis. Int J Gynaecol Obstet 124:169–173. CrossRefPubMedGoogle Scholar
  4. Chapman BP, Fiscella K, Kawachi I, Duberstein P, Muennig P (2013) Emotion suppression and mortality risk over a 12-year follow-up. J Psychosom Res 75:381–385. CrossRefPubMedPubMedCentralGoogle Scholar
  5. Collins MM, Bradley CP, O'Sullivan T, Perry IJ (2009) Self-care coping strategies in people with diabetes: a qualitative exploratory study. BMC Endocr Disord 9:6. CrossRefPubMedPubMedCentralGoogle Scholar
  6. Compare A et al (2013) Social support, depression, and heart disease: a ten year literature review. Front Psychol 4:384. CrossRefPubMedPubMedCentralGoogle Scholar
  7. Compare A, Zarbo C, Shonin E, Van Gordon W, Marconi C (2014) Emotional regulation and depression: a potential mediator between heart and mind. Cardiovasc Psychiatry Neurol 2014:324374. CrossRefPubMedPubMedCentralGoogle Scholar
  8. Cook SA, Salmon P, Dunn G, Holcombe C, Cornford P, Fisher P (2015) The association of metacognitive beliefs with emotional distress after diagnosis of cancer. Health Psychol 34:207–2015CrossRefPubMedGoogle Scholar
  9. Cordova MJ, Giese-Davis J, Golant M, Kronnenwetter C, Chang V, McFarlin S, Spiegel D (2003) Mood disturbance in community cancer support groups: the role of emotional suppression and fighting spirit. J Psychosom Res 55:461–467CrossRefPubMedGoogle Scholar
  10. Culley L, Law C, Hudson N, Denny E, Mitchell 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 19:625–639. CrossRefPubMedGoogle Scholar
  11. Dancet EA, Apers S, Kremer JA, Nelen WL, Sermeus W, D'Hooghe TM (2014) The patient-centeredness of endometriosis care and targets for improvement: a systematic review. Gynecol Obstet Investig 78:69–80. CrossRefGoogle Scholar
  12. Denny E (2004) Women’s experience of endometriosis. J Adv Nurs 46:641–648. CrossRefPubMedGoogle Scholar
  13. Denny E, Khan KS (2006) Systematic reviews of qualitative evidence: what are the experiences of women with endometriosis? J Obstet Gynaecol 26:501–506. CrossRefPubMedGoogle Scholar
  14. Donatti L, Ramos DG, Andres MP, Passman LJ, Podgaec S (2017) Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain. Einstein (Sao Paulo) 15:65–70. CrossRefGoogle Scholar
  15. Edwards RR, Bingham CO 3rd, Bathon J, Haythornthwaite JA (2006) Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum 55:325–332. CrossRefPubMedGoogle Scholar
  16. Eriksen HL, Gunnersen KF, Sorensen JA, Munk T, Nielsen T, Knudsen UB (2008) Psychological aspects of endometriosis: differences between patients with or without pain on four psychological variables. Eur J Obstet Gynecol Reprod Biol 139:100–105. CrossRefPubMedGoogle Scholar
  17. Fauconnier A, Chapron C (2005) Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update 11:595–606. CrossRefPubMedGoogle Scholar
  18. Flavell JH (1979) Metacognition and metacognitive monitoring: a new area of cognitive-developmental inquiry. Am Psychol 34:906–911CrossRefGoogle Scholar
  19. Galesic M, Bosnjak M (2009) Effects of questionnaire length on participation and indicators of response quality in a web survey. Public Opin Q 73:349–360CrossRefGoogle Scholar
  20. Hanley MA, Raichle K, Jensen M, Cardenas DD (2008) Pain catastrophizing and beliefs predict changes in pain interference and psychological functioning in persons with spinal cord injury. J Pain 9:863–871. CrossRefPubMedPubMedCentralGoogle Scholar
  21. Huntington A, Gilmour JA (2005) A life shaped by pain: women and endometriosis. J Clin Nurs 14:1124–1132. CrossRefPubMedGoogle Scholar
  22. Jensen MP, Turner JA, Romano JM, Karoly P (1991) Coping with chronic pain: a critical review of the literature. Pain 47:249–283CrossRefPubMedGoogle Scholar
  23. Kennedy S et al (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20:2698–2704. CrossRefPubMedGoogle Scholar
  24. Key BL, Campbell TS, Bacon SL, Gerin W (2008) The influence of trait and state rumination on cardiovascular recovery from a negative emotional stressor. J Behav Med 31:237–248. CrossRefPubMedGoogle Scholar
  25. Kvillemo P, Branstrom R (2014) Coping with breast cancer: a meta-analysis. PLoS One 9:e112733. CrossRefPubMedPubMedCentralGoogle Scholar
  26. Lemaire GS (2004) More than just menstrual cramps: symptoms and uncertainty among women with endometriosis. J Obstet Gynecol Neonatal Nurs 33:71.79CrossRefGoogle Scholar
  27. Levin KA (2006) Study design III: cross-sectional studies. Evid Based Dent 7:24–25. CrossRefPubMedGoogle Scholar
  28. Mann CJ (2003) Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emerg Med J 20:54–60CrossRefPubMedPubMedCentralGoogle Scholar
  29. Martin CE, Johnson E, Wechter ME, Leserman J, Zolnoun DA (2011) Catastrophizing: a predictor of persistent pain among women with endometriosis at 1 year. Hum Reprod 26:3078–3084. CrossRefPubMedPubMedCentralGoogle Scholar
  30. Meints SM, Stout M, Abplanalp S, Hirsh AT (2016) Pain-related rumination, but not magnification or helplessness, mediates race and sex differences in experimental pain. J Pain.
  31. Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ (2004) Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol 160:784–796. CrossRefPubMedGoogle Scholar
  32. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341. CrossRefPubMedGoogle Scholar
  33. Nunnink S, Meana M (2007) Remembering the pain: accuracy of pain recall in endometriosis. J Psychosom Obstet Gynaecol 28:201–208. CrossRefPubMedGoogle Scholar
  34. Popay J et al. (2006) Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme. Lancaster University, Lancaster.
  35. Pope CJ, Sharma V, Sharma S, Mazmanian D (2015) A systematic review of the association between psychiatric disturbances and endometriosis. J Obstet Gynaecol Can 37:1006–1015CrossRefPubMedGoogle Scholar
  36. Quartana PJ, Bounds S, Yoon KL, Goodin BR, Burns JW (2010) Anger suppression predicts pain, emotional, and cardiovascular responses to the cold pressor. Ann Behav Med 39:211–221. CrossRefPubMedGoogle Scholar
  37. Quinones M, Urrutia R, Torres-Reveron A, Vincent K, Flores I (2015) Anxiety, coping skills and hypothalamus-pituitary-adrenal (HPA) axis in patients with endometriosis. J Reprod Biol Health 3:1–8.
  38. Roomaney R, Kagee A (2016) Coping strategies employed by women with endometriosis in a public health-care setting. J Health Psychol 21:2259–2268. CrossRefPubMedGoogle Scholar
  39. Ruiz-Aranda D, Salguero JM, Fernandez-Berrocal P (2010) Emotional regulation and acute pain perception in women. J Pain 11:564–569. CrossRefPubMedGoogle Scholar
  40. Ruiz-Aranda D, Salguero JM, Fernandez-Berrocal P (2011) Emotional intelligence and acute pain: the mediating effect of negative affect. J Pain 12:1190–1196. CrossRefPubMedGoogle Scholar
  41. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312:71–72CrossRefPubMedPubMedCentralGoogle Scholar
  42. Salovey P, Bedell BT, Detweiler JB, Mayer JD (1999) Coping intelligently. In: Snyder CR (ed) Coping: the psychology of what works. Oxford University Press, New York, pp 141–164Google Scholar
  43. Sica C, Steketee G, Ghisi M, Chiri LR, Franceschini S (2007) Metacognitive beliefs and strategies predict worry, obsessive–compulsive symptoms and coping styles: a preliminary prospective study on an Italian non-clinical sample. Clin Psychol Psychother 14:258–268CrossRefGoogle Scholar
  44. Slatcher RB, Pennebaker JW (2007) Emotional expression and health. In: Susan Ayers AB, Chris McManus, Stanton Newman, Kenneth Wallston, John Weinman, Robert West (eds) Cambridge Handbook of Psychology, Health & Medicine. Cambridge University Press, Cambridge, pp 84–87. Scholar
  45. Spada MM, Gay H, Nikčevic AV, Fernie BA, Caselli G (2016) Meta-cognitive beliefs about worry and pain catastrophising as mediators between neuroticism and pain behaviour. Clin Psychol 20:138–146CrossRefGoogle Scholar
  46. Stowers Johansen P, Kohli H (2012) Long-term HIV/AIDS survivors: coping strategies and challenges. J HIV AIDS Soc Serv 11:6–22CrossRefGoogle Scholar
  47. Strobel C, Hunt S, Sullivan R, Sun J, Sah P (2014) Emotional regulation of pain: the role of noradrenaline in the amygdala. Sci China Life Sci 57:384–390. CrossRefPubMedGoogle Scholar
  48. Sullivan MJL (2009) The pain catastrophizing scale: user manual. McGill University, MontrealGoogle Scholar
  49. Sullivan MJ, Martel MO, Tripp D, Savard A, Crombez G (2006) The relation between catastrophizing and the communication of pain experience. Pain 122:282–288. CrossRefPubMedGoogle Scholar
  50. Taylor SE, Stanton AL (2007) Coping resources, coping processes, and mental health. Annu Rev Clin Psychol 3:377–401. CrossRefPubMedGoogle Scholar
  51. Thomas E, Moss-Morris R, Faquhar C (2006) Coping with emotions and abuse history in women with chronic pelvic pain. J Psychosom Res 60:109–112. CrossRefPubMedGoogle Scholar
  52. Turner JA, Jensen MP, Warms CA, Cardenas DD (2002) Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury. Pain 98:127–134CrossRefPubMedGoogle Scholar
  53. Vigano P, Parazzini F, Somigliana E, Vercellini P (2004) Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 18:177–200. CrossRefPubMedGoogle Scholar
  54. Wells A, Simons M (2013) Metacognitive therapy. Thinking Differently about Thinking. John Wiley & Sons Ltd, Chichester.
  55. Young K, Fisher J, Kirkman M (2017) Clinicians’ perceptions of women’s experiences of endometriosis and of psychosocial care for endometriosis. Aust N Z J Obstet Gynaecol 57:87–92. CrossRefPubMedGoogle Scholar
  56. Zarbo C, Compare A, Baldassari E, Bonardi A, Romagnoni C (2013) In sickness and in health: a literature review about function of social support within anxiety and heart disease association. Clin Pract Epidemiol Ment Health 9:255–262. CrossRefPubMedPubMedCentralGoogle Scholar
  57. Zeidner M, Matthews G, Roberts RD (2012) The emotional intelligence, health, and well-being nexus: what have we learned and what have we missed? Appl Psychol Health Well Being 4:1–30. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  1. 1.Department of Human and Social ScienceUniversity of BergamoBergamoItaly
  2. 2.Department of Obstetrics & GynaecologyHospital Papa Giovanni XXIIIBergamoItaly
  3. 3.Department of PsychiatryHospital Papa Giovanni XXIIIBergamoItaly

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