Endometriosis and chronic pain syndrome: The role of stress mechanisms

Patients with endometriosis report increased levels of perceived stress, which correlates with disease severity and pain intensity, creating feedback loops that perpetuate the cycle of endometriosis inflammation, chronic pain syndrome, and pathological stress response. Stress and chronic pain form an integrated biopsychosocial system in which neuroendocrine dysregulation, central sensitization, neuroinflammation, large-scale network reorganization, and maladaptive threat learning mutually reinforce each other. Sex differences, developmental experiences, and resilience factors modulate this interaction. Chronic pain in endometriosis emerges as the result of a progressive integration of peripheral inflammation and central nervous system plasticity. Thus, mechanism-based therapeutic strategies for endometriosis-associated pain should address both peripheral drivers and central amplification processes. Further research is needed to better understand whether chronic stress is a contributing cause for the onset of endometriosis and whether there is an opportunity to modify this risk factor before endometriosis is fully established.