Linking Childhood Trauma to Endometriosis - Evidence and Implications for Reproductive Health Screening - Practical Screening Guidance

Sep 29, 2026

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The editorial links childhood trauma exposure, assessed with validated instruments such as the Childhood Trauma Questionnaire (CTQ), to higher risk of later mental-health disorders and chronic disease, focusing on endometriosis. Endometriosis is described as a chronic inflammatory condition requiring lesion visualization and histological confirmation. Prevalence, multifactorial mechanisms, and stress-related neuro-immune changes are summarized, followed by practical screening guidance, tool selection, safety assessment, referrals, and limitations of screening instruments.

LanguageEnglish

CategoryHealthcare

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Linking Childhood Trauma to Endometriosis

Evidence and Implications for Reproductive Health Screening

Practical Screening Guidance

When to Consider Trauma Inquiry

Brief Validated Tools for Initial Screening

If a Screen Is Positive

Editorial # Linking childhood trauma to endometriosis: evidence and implications for reproductive healthscreening Noor Un Nisa Irshad, MBBSa ,* Muhammad Mudasir Atif, MBBSa , Muhammad Talha, MBBSb ,Mohammed Hammad Jaber Amin, MBBSc ,* Dear Editor, Childhood trauma is exposure to high-stress events that canpotentially be traumatic. Such events usually include sexual, emo -tional, and physical abuse, and emotional and physical neglect byparents or guardians. Exposure to childhood maltreatment, whichis commonly measured with instruments such as the ChildhoodTrauma Questionnaire (CTQ), is associated with increased risk oflater mental-health disorders and many chronic diseases[1] .Endometriosis is a chronic inflammatory condition in which tissuesimilar to that lining the inside of the uterus grows outside of it.Diagnosis typically requires visualization of lesions (usually atlaparoscopy) with histological confirmation, and disease extentis commonly classified using the revised ASRM staging system[2] .This includes symptoms of chronic pelvic pain and infertility[3] . Endometriosis affects about 10–15% of women of reproduc -tive age, estimated to be around 190 million worldwide[4] . Itisgenerally a complex, multifactorial condition and has genetic,hormonal, immunological, and environmental influences. Mostrecently, adverse childhood experiences (ACE) have been high -lighted as important factors in the development and progressionof endometriosis[3,5] . Endometriosis may reflect hypothalamic -pituitary-adrenal (HPA)-axis dysregulation and related immune/inflammatory changes associated with early-life stress, a plausiblebut still hypothetical pathway supported primarily by indirectevidence. Observed associations include elevated pro-inflamma -tory markers (e.g., CRP, IL-6, TNF-α), altered cortisol/HPA-axisdynamics after early adversity, and increased central painsensiti -zation in endometriosis-associated pain. These findings supporthypotheses linking early stress to altered neuro-immune function aDepartment of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan,bDepartment of Medicine, King Edward Medical University, Lahore, Pakistan andcDepartment of Medicine, Faculty of Medicine, AlzaiemAlazhari University,Khartoum, Sudan Sponsorships or competing interests that maybe relevant to content are disclosedatthe end of this article. *Corresponding author. Address: Department of Medicine, Faculty of Medicine,AlzaiemAlazhari University, Khartoum 1111, Sudan. Tel.: +249 11 930 3629.E-mail: mohammesjaber123@gmail.com (M. H. Jaber Amin). Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is anopen access article distributed under the terms of the Creative CommonsAttribution-NonCommercial-ShareAlike 4.0 License, which allows otherstoremix,tweak, and build upon the work non-commercially, as long as the author is creditedandthe new creations are licensed under the identical terms. Annals of Medicine & Surgery (2026) 88:7–8Received 6 August 2025; Accepted 31 October 2025Published online 14 November 2025http://dx.doi.org/10.1097/MS9.0000000000004321 # Practical screening guidance: ● When to consider trauma inquiry: consider a brief traumascreen for patients presenting with chronic pelvic pain,severe dysmenorrhea, unexplained infertility, or treat -ment-resistant pelvic pain[1-3,5,6] . ● Brief validated tools, examples for initial screening:Childhood Trauma Questionnaire (CTQ and short formssuch as CTQ-SF) (used in endometriosis research)[1];adverse-childhood-experience (ACE) constructs/question -naires (e.g., 10-item ACE) or register-based ACEmeasures[3]; and a short PTSD screen (e.g., PC-PTSD-5)when PTSD is suspected. [1-3] ● If a screen is positive: assess immediate safety (current abuse,suicidality), use trauma-informed communication, offerreferral to mental-health services, and arrange multidisci -plinary care linking gynecology with mental-health/painspe -cialists. Document finding

FAQs

When should clinicians consider trauma inquiry in patients?

Consider brief trauma screening for patients with chronic pelvic pain, severe dysmenorrhea, unexplained infertility, or treatment-resistant pelvic pain.

Which brief validated tools are suggested for initial screening?

Recommended tools include the Childhood Trauma Questionnaire (CTQ and CTQ-SF), adverse childhood experience (ACE) questionnaires or register-based measures (e.g., 10-item ACE), and a short PTSD screen such as PC-PTSD-5 when PTSD is suspected.

What steps should be taken if a trauma screen is positive?

Assess immediate safety (current abuse and suicidality), use trauma-informed communication, offer referral to mental-health services, arrange multidisciplinary care linking gynecology with mental-health and pain specialists, document findings, and ensure confidentiality.

Sep 29, 2026

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