Psychotherapy for People Living With Endometrosis and Adenomyosis
Living With Endometriosis and Adenomyosis
Endometriosis and adenomyosis are two estrogen-dependent conditions that are characterized by abnormal endometrial-like tissue growth. Both conditions can trigger chronic inflammation, immune system changes, and tissue injury cycles. Common symptoms include painful periods, heavy menstrual bleeding, pelvic pain, and fertility struggles. Endometriosis is a systemic condition that has high rates of co-occurrence with other conditions including autoimmune conditions, migraines, fibromyalgia, interstitial cystitis, Irritable Bowel Syndrome, PMDD, and chronic pelvic pain including pelvic floor dysfunction.
In addition, both endometriosis and adenomyosis are associated with higher risk of anxiety and depression.
There is no cure for these conditions, but there are treatment options.
Endometriosis is estimated to affect about 10-15% of women of reproductive age. At least 20% of women (and maybe considerably more) are affected by adenomyosis.
As anyone who lives or knows someone with these conditions, endometriosis and adenomyosis are woefully undertreated, understudied, and underdiagnosed, with people waiting between four to 11 years on average to receive a diagnosis of endometriosis.
The Whole-Body Impact of Endometriosis and Adenomyosis
These conditions can trigger sustained low-grade inflammation and impact much more than the pelvis. Endometriosis can be conceptualized as a chronic, systemic, and inflammatory disorder.
Treatment Guidelines for Endometriosis
In 2026, The American College of Obstetricians & Gynecologists published new treatment guidelines for endometriosis. It is no longer necessary for laparoscopic surgery to confirm endometriosis and instead a presumptive clinical diagnosis can be made based on history, symptoms, physical examination, and imaging (such as a transvaginal ultrasound or in some cases a pelvic MRI). These guidelines are intended to decrease the delay before receiving treatment - surgery is no longer required to start treatment. Laparoscopic surgical excision is still the gold standard for surgical treatment. The guidelines also center on the importance of shared decision making, including whether to pursue surgery or medical management (hormone therapies and over-the-counter pain relievers) based on each individual’s unique priorities and concerns. There are no drugs that are specifically labeled for treatment of adenomyosis, with a focus on managing heavy bleeding and cramps through birth control pills, hormone-releasing IUDs, and blood-thinning medications.
When to Suspect Endometriosis and Adenomyosis
Under the new ACOG treatment guidelines, endometriosis such be suspected when there is at least one of these symptoms present:
Chronic pelvic pain
Painful periods (dysmenorrhea)
Pain with sex (dyspareunia), urination (dysuria), or bowel movements (dyschezia)
Infertility
While approximately one out of three people with adenomyosis are asymptomatic, heavy menstrual bleeding is the most common sign of adenomyosis. For many, adenomyosis is an incidental finding.
While adenomyosis and endometriosis are distinct conditions, they very often co-occur.
A Multidisciplinary Approach to Endometriosis
In addition to recommended treatments, which includes excisional surgery and medical management, pelvic floor physical therapy is an effective treatment to help with endometriosis and adenomyosis symptoms, including with chronic pelvic pain. There are other pain management strategies that can help, including mindfulness-based interventions and use of a TENS unit for pain management. Yoga, Pilates, and aerobic exercise can help lower inflammation, which may in turn decrease pain. Endometriosis management may also benefit from dietary changes and supplements, such as magnesium, turmeric, and Omega-3s. Integrated care is a necessity for those living with these conditions.
How Psychotherapy Can Help With Endometriosis and Adenomyosis
Holistic Treatment Approach for Endometriosis and Adenomyosis
Holistic treatment means coordination between a multidisciplinary care team, treatment options, management, and ongoing mental health support. Psychological care is an essential aspect of a multidisciplinary care model.
Psychological Complexities of Living With Endometriosis and Adenomyosis
For people living with endometriosis and adenomyosis, and those who love them, both individual and couples psychotherapy can be helpful. In general, it is helpful to work with a therapist who specializes with chronic illness, but even then these conditions are not emphasized enough in mental health training. Given at least 10% of women of reproductive age experience endometriosis and adenomyosis may impact one out of three women (or more), a holistic and integrated approach by mental health providers is essential.
When I support those living with endometriosis and adenomyosis, we delve into overlapping traumas (including not being believed, having care delayed, medical trauma, invalidation); the immensity of grief (including from reproductive health concerns, lost opportunities and relationships, and the reality of living in a body with chronic pain); the intricacies of chronic pain (including the process of central sensitization, managing co-occurring health conditions, working with the necessary hypervigilance, bracing, and restriction), and the practical aspects of living with these conditions (including managing time, energy, boundaries, planning for the future). There can be so much stored in and around the pelvis - years of anguish, rage, frustration, shame, loneliness, and heartache. For many, it isn’t just about the pain and challenges from living with endometriosis and adenomyosis, but the added complications of living with an underdiagnosed, underresearched, and undertreated condition.
Recommended Psychotherapy Modalities
These conditions are complex and require integrated psychotherapy treatment. In one session, a person may need help with more practical aspects such as navigating boundaries, advocating through medical systems, responding to pain flares, and asking for and receiving support. In another, a person may need support around the deeper layers, including tending to the grief, rage, sadness, fear, and loneliness that can come with endometriosis and adenomyosis. According to one meta-analysis, psychological treatments have been found to have moderate positive effects on pain levels and moderate to strong positive effects on anxiety and depression experienced by women with endometriosis.
In my work, these are main treatments I have found helpful to blend together in sessions:
Pain Reprocessing Therapy: Through PRT, we can learn to work with central sensitization and send signals of relative safety to the nervous system, in turn quieting pain signals and addressing any neuroplastic components of pain. PRT interrupts the pain-stress-pain loop, softening the body’s threat detection systems and thereby addressing interrelated responses to chronic pain including fatigue, sleep issues, anxiety, and depression. PRT is a complement to existing medical treatments, working to address the central sensitization which may be a possible mechanism for certain (but not all) aspects of endometriosis pain.
Acceptance and Commitment Therapy: ACT is a powerful way of moving with pain into greater psychological flexibility. I find it to be a useful framework to navigate through the tangle of chronic pain, which often includes components of anxiety, trauma, depression, avoidance, and isolation, with purposeful movement in the direction of our heart’s deepest longings. ACT is practical and experiential. ACT can help people show up, make space, and experience life in ways more aligned with their dearest values. It is deeply human to want to be free from pain. And yet, what would it mean to show up fully in your life and not need to wait to be out of pain to live? As scary and distressing as that may feel, through ACT we can see how suffering against pain engenders further pain. ACT provides direct, clear guidance of how to do what may sound impossible - through Accepting experiences, Choosing behaviors mindfully, and Taking action and having agency in your life.
EMDR: Many people later diagnosed with endometriosis and adenomyosis have lived through years of traumatic experiences, including medical trauma, invalidation, and painful or scary medical procedures resulting in trauma related symptoms or PTSD. Although EMDR is often thought of as a trauma treatment, it can be effectively used to help process grief and anxiety, which in turn can help with chronic pain symptoms. One unique component to living with endometriosis and adenomyosis is the knowing that life could have been different had these conditions been treated properly earlier. EMDR is one way I use to work with this deep grief/rage/hurt/disappointment/abandonment/fear that can be present, especially if someone has spent years languishing in pain.
Internal Family Systems (IFS): Internal Family Systems is a non-pathologizing approach to understanding our psyche, seeing ourselves through the lens of different parts. With endometriosis and adenomyosis, these parts might include the ones that hold the pain, hold us together, numb out, store deep grief, isolate, look for a fix, and so on. In IFS, you can learn how to hold all of these parts with kindness and compassion, understanding how they hurt and want to help, and offer long-lasting healing from your true Self. Acknowledgment, curiosity, and understanding are cornerstones of IFS. Through getting to know your system, you can begin to map out where the pain is and offer the possibility of unburdening to your system.
Somatic Experiencing (SE): SE works to resolve symptoms of stress, shock, and trauma that can accumulate in our bodies and nervous systems. Using tracking, pendulation, orienting, resourcing, and other ways of being in the body, SE can help people living in pain find more easeful ways of living in the world. SE can be especially helpful in navigating, preparing, and recovering from surgeries.
Cognitive Behavior Therapy (CBT): Although further research is needed, there is some evidence suggesting that CBT can help with the emotional side to endometriosis suffering through modification of maladaptive cognitive perceptions and behaviors. CBT techniques such as mindfulness, coping strategies, behavioral strategies such as relaxation, and psychoeducation may provide some help.
Mindfulness-based stress reduction (MBSR) and other mindfulness-based approaches: There is a wealth of research pointing to positive impacts from mindfulness-based approaches and chronic pain. Although only minimal research has looked into the benefits of MBSR for people living with endometriosis, these approaches can help improve quality of life.
Clinical Sexology: Clinical sexology is a multidisciplinary therapeutic and educational approach, rooted in the bio-psycho-social model. Endometriosis and adenomyosis can impact sexual intimacy and desire. Clinical sexology provides a way to work through common issues during sex, which can include pain with penetration, getting distracted, feeling fearful or triggered, or bracing. Sensory focus techniques as well as certain sexual positions can help with dyspareunia.
FAQS
What kind of psychotherapy approaches help with trauma?
Due to years of medical gaslighting and other forms of medical trauma, some women living with endometriosis and adenomyosis may develop symptoms of traumatic stress, including PTSD. In addition, according to 2025 article from JAMA Psychiatry, individuals with endometriosis are more likely to report traumatic experiences, suggesting a connection between contact traumas and endometriosis independent of genetic disease predisposition. According to the American Psychological Association’s (APA’s) treatment guidelines, the first-line trauma treatments are Cognitive Behavioral Therapy (CBT), Prolonged Exposure Therapy (PE), and Cognitive Processing Therapy (CPT). The APA’s recommended second-line treatments are Cognitive Therapy, EMDR, and Narrative Exposure Therapy (NET).
What kinds of psychotherapy approaches can help someone with endometriosis and adenomyosis?
Some combination of “top-down” and “bottom-up” therapy approaches can help, such as a blend of Pain Reprocessing Therapy (PRT), Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), trauma treatments including EMDR and Written Exposure Therapy (WET), and somatic or mindfulness based approaches.
What’s your approach to supporting people with endometriosis and adenomyosis?
As mental health providers, we need to be educated about how endometriosis and adenomyosis impact people’s comprehensive well-being. Pain is the hallmark of endometriosis. These conditions can trigger body-wide complications and wide-ranging psychological impacts, requiring an integrative approach to therapy. I use a bio-psycho-social lens in my work, blending “top-down” approaches such as Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) with more “bottom-up” approaches including EMDR and Somatic Experiencing (SE). I use therapeutic approaches that can be particularly helpful for people living in chronic pain, including Pain Reprocessing Therapy (PRT), Internal Family Systems (IFS), Emotional Awareness and Expression Therapy (EAET), clinical sexology, and mindfulness-based approaches. I also integrate components of Pelvic Floor Yoga (Leslie Howard) and Qigong for women’s health (Daisy Lee) as appropriate. I focus on supporting quality of life and fostering overall well-being.
Additional Support
For those navigating the challenges that come with endometriosis and adenomyosis, having someone who can accompany you through the pain is essential. I offer a deeply personalized and intentional approach, blending my therapy background with mind-body approaches including yoga, Qigong, and mindfulness. As Mary Oliver writes, “life has some possibility left.” It is possible to feel more connected, grounded, and at ease in your being.
