HMN 2025: How Depression is more common among women with gynecological disorders

Gynecological disorders such as endometriosis, PCOS, and menstrual irregularities are common and often associated with pain and disruption to everyday life. They are typically diagnosed late, and many women experience both physical discomfort and mental distress for years before receiving treatment.

Now, a new register-based study from the University of Southern Denmark reveals that depression is more prevalent among women with one of the 24 most common gynecological conditions—and that mental health symptoms often appear long before a diagnosis is made.

“Many women live with psychological symptoms for years without anyone recognizing that they might be linked to physical issues in the reproductive system,” says Mette Bliddal, associate professor at the Research Unit for Gynecology and Obstetrics, Department of Clinical Research, and lead author of the study.

The study, published in the journal Psychological Medicine, found that depression was 44% more common among women with a gynecological disorder even before diagnosis. In the year leading up to and the year following diagnosis, the risk of depression was between 15% and 109% higher, depending on the specific condition.

Large-scale register study over 13 years

The study draws on Danish health data for over 2.2 million women aged 15 to 49, covering the years 2005 to 2018. Of these, 265,891 women, 12% had been diagnosed with at least one of 24 different reproductive disorders.

The findings show a significantly increased prevalence of depression among women with a gynecological diagnosis. This elevated risk begins well before diagnosis and peaks in the year following.

The trend is evident both among women who had received a hospital-based diagnosis of depression and those who were prescribed antidepressant medication.

“The overall picture suggests that physical discomfort and psychological distress often go hand in hand—and that it starts earlier than the health care system usually detects,” says Bliddal.

Most pronounced for painful conditions

The greatest differences in depression rates were found among women with painful conditions, such as menstrual-related pain and endometriosis. In these cases, the risk of depression was nearly twice as high as for women without these diagnoses.

“This suggests that many women may develop mental health symptoms in response to their physical discomfort, and that these reactions may be overlooked in a health care system that primarily focuses on physical symptoms,” says Bliddal.

A need for more holistic care

The study does not establish a causal link, but the clear overrepresentation of depression among women with gynecological conditions points to a need for changes in clinical practice.

The researchers call for a more integrated approach between somatic and psychiatric care, both during initial assessment and in follow-up. This applies especially to general practice and gynecological care.

“When so many women are affected by both physical and psychological burdens, we need to adopt a more holistic mindset. Systematic attention must be given to women’s mental well-being when investigating gynecological disorders,” says Bliddal.

Three questions for Mette Bliddal about the study

What does the study investigate?

We examine the prevalence of depression in women before and after being diagnosed with a reproductive disorder—conditions such as endometriosis, PCOS, and irregular or painful menstruation. We look at 24 different disorders, all related to women’s reproductive health.

What is the most important finding?

For all the conditions studied, we see a higher prevalence of depression among women who are later diagnosed with one of these disorders, compared to women without. This increased prevalence is already visible three years before diagnosis and can persist for up to three years afterwards.

How can the results be used?

Although we cannot determine causality, the study clearly shows that women’s mental health may be significantly affected by disorders of the reproductive system.

About the study

The study is based on Danish registry data and was conducted by researchers at the University of Southern Denmark in collaboration with New York University, among others.

It is a register-based cohort study covering the period from 2005 to 2018.

It includes:

• 2,295,824 women aged 15–49
• 265,891 women with at least one diagnosis from a list of 24 gynecological disorders, including endometriosis, PCOS, menstrual irregularities, and pelvic pain
• For each diagnosed woman, five peers without reproductive diagnoses were selected as a comparison group
• Depression was measured either as a hospital diagnosis (ICD-10: F32–F39) or as redemption of antidepressant medication (ATC code N06A)
• Depression rates were tracked from three years before to three years after diagnosis

Data came from the Danish National Patient Register and the Danish National Prescription Registry, allowing the researchers to monitor both moderate and severe cases of depression over time.

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