Neuropsychiatric and cognitive manifestations of endometriosis: insights into the ‘endometriosis brain’

This review explores the multifaceted impact of endometriosis on women’s health, emphasizing its association with neuropathic pain, cognitive dysfunction, migraine, mental health disorders, and reduced quality of life. Central sensitization plays a crucial role in the persistence and severity of neuropathic pain in endometriosis, driven by glial activation, neuroplasticity, and microbial dysbiosis, often leading to heightened pain sensitivity beyond ectopic tissue presence. Cognitive impairments, characterized as “brain fog”, involve disrupted brain connectivity, neuroinflammation, and hormonal imbalances, contributing to daily functional challenges. The coexistence of migraine exacerbates disease burden, sharing inflammatory pathways and hormonal sensitivities, yet remains under-treated. Anxiety and depression are prevalent, mediated by neuroinflammatory processes, chronic pain, and psychosocial stressors, significantly impairing mental health and social functioning. Furthermore, endometriosis substantially decreases quality of life across physical, emotional, and social domains, often surpassing other chronic conditions. Despite the complex symptomatology, current management strategies require a multidisciplinary approach, integrating pain control, mental health support, and personalized therapies to improve overall outcomes. Recognizing and addressing these interconnected aspects is essential for advancing patient care and enhancing quality of life for women affected by endometriosis.