Childhood Stress Linked to Increased Risk of Endometriosis: Large Swedish Study Reveals

A large, recent study from Sweden has found a significant association between difficult or stressful childhood experiences and an increased risk of being diagnosed with endometriosis in adulthood. This research involving over a million women suggests that childhood stressors may influence the development or symptoms of this chronic gynecological condition, with implications for diagnosis, treatment, and preventive healthcare.

Key Findings from the Swedish Nationwide Study

Published in the journal Human Reproduction in mid-2025, the study led by Marika Rostvall and colleagues at Karolinska Institutet analyzed data from 1,316,946 women born over 27 years in Sweden. Among these women, 24,311 were diagnosed with endometriosis as recorded in health registers. The researchers examined a broad spectrum of adverse childhood experiences (ACEs) including parental substance abuse, intellectual disability, psychiatric disorders, familial death, having a teenage parent, parental separation, residential instability, exposure to interpersonal violence, receiving public assistance, and parental exposure to violence before age 15.

The study found that all the adverse experiences, except familial death, were associated with an elevated risk of endometriosis later in life, with risk increases ranging roughly from 20% to 35%. Notably, exposure to interpersonal violence more than doubled the likelihood of endometriosis diagnosis (Hazard Ratio [HR] = 2.38). There was a dose-response relationship, meaning the risk grew higher with increasing numbers of childhood adversities; women experiencing five or more had about a 60% higher risk (HR = 1.61) of developing endometriosis compared to those with none.

Possible Mechanisms Explaining the Link

The researchers proposed two main potential biological explanations for these findings:

1. Immune System Alterations: Childhood stress may cause persistent immune dysregulation or systemic inflammation, which could impair the body’s ability to remove aberrant endometrial tissue growing outside the uterus.

2. Pain Sensitization: Trauma experienced early in life could heighten the central nervous system’s sensitivity to pain. This increased pain perception may lead to more severe symptoms and thus a greater likelihood of obtaining an endometriosis diagnosis.

Marika Rostvall emphasized the importance of considering the whole person’s history, not just symptoms. She suggested these findings could influence clinical approaches by integrating psychosocial history into diagnosis and care, and promoting multidisciplinary management including mental health support and trauma-informed care.

Background on Endometriosis and Risk Factors

Endometriosis is a condition estimated to affect about 1 in 10 women of reproductive age worldwide. It is characterized by the growth of endometrial-like tissue outside the uterus, which can cause severe pelvic pain, heavy menstrual bleeding, scarring, and infertility. The precise cause remains incompletely understood, but established risk factors include:

• Family history of endometriosis (7-10 fold increased risk)

• Early onset of menstruation

• Short menstrual cycles

• Heavy or prolonged menstrual bleeding

• Immune system and hormonal factors

Environmental toxins and genetic predispositions also may play a role, but the influence of psychosocial and traumatic experiences has been less explored until recently.

Expert Commentary

Dr. Cecilia Magnusson, a co-author and epidemiologist, noted the long-term health repercussions of childhood adversity extend beyond mental health to chronic physical conditions like endometriosis. Independent experts such as Dr. Anita Sharma, a gynecologist not involved in this study, remarked that this research underscores the need for trauma-informed care in gynecology, where clinicians actively screen for stress and trauma histories to tailor treatments.

However, experts caution the study is observational and does not prove causation. Other factors may contribute to the observed association, including genetic predispositions and socio-economic confounders. More research is required to unravel the exact biological pathways linking childhood stress to gynecological health.

Implications for Public Health and Practice

This study highlights the importance of addressing early life adversity as a factor in women’s reproductive health. Integrating mental health services and trauma-sensitive approaches into endometriosis care may enhance treatment outcomes. Early identification of women at risk could lead to preventive strategies aimed at stress reduction and immune system support.

For readers and patients, understanding that psychosocial factors can influence physical health conditions is vital. Awareness of this connection may encourage seeking timely medical advice and comprehensive care involving mental health and pain management specialists.

Limitations and Counterarguments

• The study’s reliance on register-based data limits details about the severity and timing of adversities.

• Being observational, it cannot establish direct cause-effect relationships.

• Residual confounding by unmeasured factors could influence results.

• The mechanisms proposed remain theoretical pending experimental validation.

Medical Disclaimer

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.

References

• Rostvall M, Magnusson C, Gemzell-Danielsson K, Kosidou K, Sieurin J. Adverse childhood experiences and the risk of endometriosis—a nationwide cohort study. Human Reproduction. 2025; doi:10.1093/humrep/deaf101