{"paper_id":"6af92260-9ea3-4d80-bc87-247ffbfc4916","body_text":"Endometriosis is a disease defined by the presence of endometrial‐like tissue outside of the uterus (Horne and Missmer  2022 ). It is estimated to affect approximately 10% of women and people assigned female at birth globally (Allaire et al.  2023 ; Taylor et al.  2021 ), however, many individuals often face difficulty receiving a diagnosis, and thus the ability to seek appropriate treatment (Horne and Missmer  2022 ). Symptoms of endometriosis vary widely, with one of the most reported symptoms being pain (Horne and Missmer  2022 ; Saunders and Horne  2021 ), including dysmenorrhea (pain during menstruation), dyspareunia (pain during sexual intercourse), dyschezia (pain during defecation), and chronic pelvic pain (Saunders and Horne  2021 ). Additional symptoms can include affective changes, poor mental health, and reduced quality of life (Cavaggioni et al.  2014 ; Facchin et al.  2015 ). Despite its prevalence, the characteristics, causes, and impacts of endometriosis remain poorly understood (Ellis et al.  2022 ; Giudice et al.  2023 ).\nResearch has indicated that individuals with a chronic pain condition experience a range of sensory abnormalities (Stanton et al.  2016 ; Staud et al.  2012 ; Tong et al.  2017 ), and that these may extend to changes in interoception (Garfinkel and Eccleston  2025 ; Horsburgh et al.  2024 ). Interoception is a multidimensional sense that relates to our ability to detect and interpret sensations arising from inside the body, such as hunger or heartbeats (Ceunen et al.  2016 ; Craig  2002 ; Suksasilp and Garfinkel  2022 ). The exact nature and dimensional structure of interoception are debated (Murphy et al.  2019 ; Suksasilp and Garfinkel  2022 ), with the subjective report of an individual's awareness of interoceptive cues referred to by a range of terms such as interoceptive sensibility or interoceptive beliefs (Garfinkel and Critchley  2013 ). Beyond this debate on the taxonomy, changes are seen across interoceptive domains in those experiencing chronic pain. Specifically, existing research has suggested differences in an individual's subjective report of how aware they are of internal sensations (Horsburgh et al.  2024 ), referred to here as interoceptive beliefs (Suksasilp and Garfinkel  2022 ). Those with chronic pain self‐report that they notice more bodily sensations and have stronger emotional reactions to these sensations (Horsburgh et al.  2024 ).\nIt is possible that individuals with endometriosis, a condition often accompanied with significant pain, experience similar interoceptive abnormalities as those observed in chronic pain conditions. Two studies have considered whether interoceptive beliefs are altered in individuals with endometriosis, with conflicting findings reported. Cantoni et al. ( 2025 ) reported no differences in interoceptive beliefs, measured using the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA‐2), in those with and without endometriosis. In contrast, Pasternack et al. ( 2025 ) found that individuals with endometriosis scored lower in all subscales of the MAIA when compared to a control population.\nGiven the limited research and conflicted findings regarding interoceptive beliefs in individuals with endometriosis, further research is needed to clarify this relationship. Additionally, there has been no investigation of whether pain intensity can predict interoceptive beliefs in endometriosis, despite the possibility of an interaction between these factors (Horsburgh et al.  2024 ). Therefore, in this study, our primary aim was to compare interoceptive beliefs in those with and without endometriosis. Our secondary aim was to assess whether pain experienced by those with endometriosis predicts interoceptive beliefs. We hypothesised that those with endometriosis will have altered interoceptive beliefs compared to individuals without endometriosis and that pain will predict interoceptive beliefs in those with endometriosis.\n\nThis study used a cross‐sectional open survey design. Ethics approval was obtained from the local human research ethics committee (HREC‐13953). The survey was part of a broader study considering sensory and cognitive changes in those with endometriosis. The study is reported in accordance with the Checklist for Reporting Results of Internet E‐surveys (CHERRIES; Eysenbach  2004 ).\nAn a priori power analysis was performed using G*Power (Version 3.1.9.7; Faul et al.  2007 ) to determine the minimum necessary sample size to detect a difference in interoceptive beliefs between those with and without endometriosis, using a Linear Multiple Regression: fixed model,  R \n 2  increase. To determine how to power the study appropriately, effect sizes for the previous study by Cantoni et al. ( 2025 ) were calculated for each subscale of the MAIA‐2. This was done through G*Power, using an ANOVA, fixed effects, omnibus, one‐way model and the means and standard deviations published by Cantoni et al. ( 2025 ). Calculated effect sizes ranged from very small ( f  = 0.019; Attention Regulation subscale) to medium ( f  = 0.2; Not Worrying subscale). Based on this, the parameters chosen for this study were a small to medium effect size ( f  = 0.1), α error probability of 0.05, power of 0.8, one tested predictor and three total predictors. This analysis indicated a minimum required sample of 81 participants in total.\nA total of 971 premenopausal women and individuals who were assigned female at birth expressed interest in completing the study, with 961 consenting to participate in the study. 292 people either met exclusion criteria or chose not to proceed with participation before completing any questionnaires. Exclusion criteria included being assigned male at birth, having a partial or complete hysterectomy, being currently pregnant or trying to conceive, currently breastfeeding, currently experiencing menopause, having suspected endometriosis that has not been confirmed through surgery or medical imaging, being below the age of 18, and residing outside of Australia. Of the 669 participants who began the survey, 324 withdrew before completing the pain and interoception measures relating to this study. These participants were therefore excluded from analysis, resulting in a sample of 345 participants. Of these 345 participants, 247 reported that they had been diagnosed with endometriosis and 98 reported no endometriosis diagnosis.\nInformation relating to participants' age, gender, relationship status, and education level (highest achieved) was collected. Participants were also asked if they had been diagnosed with a mental health condition or neurodevelopmental disorder and asked to specify their diagnosis. Specific information regarding endometriosis diagnoses was also gathered. All participants were asked whether they had a diagnosis of endometriosis, confirmed through either surgical procedure or medical imaging, when they were diagnosed, whether they were using contraception, whether they had been diagnosed with any other gynaecological health conditions, were experiencing pelvic pain, or were currently experiencing any other chronic pain condition.\nInteroceptive beliefs were assessed using the MAIA‐2 (Mehling et al.  2018 ). Participants were presented with a series of 37 statements and asked to indicate how often each statement applies to them in daily life. Responses were scored on a 6‐point Likert scale, with a score of 0 representing the statement ‘never applies’ and a score of 5 signifying that the statement ‘always applies’. The MAIA‐2 contains eight subscales, with scores presented as a mean across each subscale. Subscales include Noticing (awareness of all body sensations), Not Distracting (use of distraction to cope with painful or uncomfortable interoceptive sensations), Not Worrying (worry associated with painful or uncomfortable interoceptive sensations), Attention Regulation (ability to direct and sustain attention toward bodily sensations), Emotional Awareness (ability to connect emotional states and bodily sensations), Self‐Regulation (ability to use bodily sensations to cope with distress), Body Listening (use of internal sensations for insight), and Trusting (level of trust an individual holds toward their body; Mehling et al.  2018 ,  2012 ). The MAIA‐2 is a validated measure of interoceptive beliefs and has been used widely in previous research considering the relationship between interoception and pain (Delafin et al.  2022 ; Mehling et al.  2018 ,  2012 ).\nDysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain were assessed using four numerical rating scales (NRS). Participants were asked to indicate the average intensity of their pain across these four symptoms over the previous four weeks on a scale from 0 to 100, with reference markers every 10 units (e.g., markers at 0, 10, 20 etc.). Descriptors were provided at scores of 0 (‘no pain’) and 100 (‘worst pain imaginable’). Similar measures of pain intensity have been used in previous research assessing the experiences of those with endometriosis (Cantoni et al.  2025 ) and are consistent with recommendations for pain assessment in those with endometriosis (Bourdel et al.  2015 ).\nData collection for the study ran between March 2024 and March 2025. Those interested in participating in the study accessed the survey via Qualtrics (Provo, UT). Participants were recruited through convenience and snowball sampling methods. The study was advertised across a range of social media platforms, including the pages of national endometriosis awareness groups. The study was also advertised on local and national news. Physical flyers were placed in various locations at the University of Canberra, with information about how to participate and a linking QR code. Finally, the study was advertised on the University's online research participation platform. Students enrolled in undergraduate Psychology courses at the University of Canberra could complete the survey for course credit. All other participants had a chance to win one of five $50 gift vouchers for participating. The usability and technical functionality of the survey were tested within the research team, and modifications were made to improve clarity prior to its release. The survey took approximately 45 min to complete. To reduce the risk of inauthentic participants, financial incentives were not automatically granted, and the time taken to complete the survey was reviewed to ensure there were no suspicious responses.\nWhen interested individuals accessed the survey via Qualtrics, they were first presented with an information sheet outlining the aims of the project, possible risks and benefits of participating in the study, and contact details for the research team and the University's Research Ethics and Integrity Unit team. After reading this form, individuals could indicate whether they had read the information and consented to participate, or if they did not wish to continue. Once informed consent was obtained, participants completed eligibility screening before proceeding with the survey. Demographic information, including whether participants had a diagnosis of endometriosis, was presented to all participants, along with period profiling questions and the four pain NRS's. Finally, all participants completed the MAIA‐2. The questionnaires were presented in a consistent order to all participants.\nAll statistical analyses were completed using IBM SPSS Statistics (Version 29). The data were cleaned, with outliers detected by calculating  z ‐scores for each dependent variable. Outliers ( z ‐scores > 3; Bordens and Abbott  2007 ) were detected in the Noticing ( n  = 2), Not Distracting ( n  = 5), and Emotional Awareness ( n  = 2) subscales of the MAIA‐2. The analyses were run with and without outliers included. The inclusion of outliers did not affect the direction or magnitude of results. As such, to provide a more complete account of the collected data, all outliers were included in the final analyses. Missing data were present for two of the demographic variables, with three participants not providing their age and 13 participants not reporting their contraceptive usage. The three participants who did not report their age were not included in the regression analysis as age was a controlled factor in the model.\nParticipants were included in the endometriosis group if they reported a diagnosis of endometriosis through either surgical procedure or medical imaging. To test for differences in interoceptive beliefs between those with and without a diagnosis of endometriosis (Aim 1), we conducted eight hierarchical multiple regressions with endometriosis diagnosis as the independent variable (endometriosis = 1, non‐endometriosis = 0) and each MAIA subscale (Noticing, Not Distracting, Not Worrying, Attention Regulation, Emotional Awareness, Self‐Regulation, Body Listening, and Trusting) as the dependent variable. In the first step of each regression model, we input age and mental health or neurodevelopmental diagnosis (no mental health or neurodevelopmental diagnosis = 1, mental health or neurodevelopmental diagnosis = 0) to control for the impact of these factors on interoceptive processing (Brewer et al.  2021 ; Khalsa et al.  2018 ; Murphy et al.  2018 ). In the second step of each model, we added diagnosis of endometriosis (yes; no) as a predictor to determine the effect of endometriosis diagnosis on interoceptive beliefs. Figure  1  presents mean interoceptive scores for each subscale between those with and without endometriosis.\nBar chart showing the mean scores for each subscale of the MAIA in those with (light grey) and without (dark grey) a diagnosis of endometriosis. Error bars represent the standard error for each subscale. Subscales where endometriosis diagnosis explained a significant amount of unique variance in scores are indicated with an asterisk.\nTo investigate the relationship between pain intensity and interoceptive beliefs, we conducted a series of hierarchical regressions. Only those interoceptive domains shown to differ between those with and without endometriosis were included as predictors. The regression models included age and mental health or neurodevelopmental diagnosis (no mental health or neurodevelopmental diagnosis = 1, mental health or neurodevelopmental diagnosis = 0) as controlled factors added at step 1, and dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain ratings included as predictors added as step 2.\nDurbin‐Watson statistics for all analyses were within an acceptable range (1.70–2.14), and visual inspection of scatterplots supported assumptions of linearity, homoscedasticity, and normality of residuals. Correlation matrices were inspected, and no multicollinearity was detected between variables using a Pearson correlation of < 0.7 as the cutoff for acceptable levels of multicollinearity.  R \n 2 , model coefficients ( β ),  f  statistics, and  p  values are presented in tables, with  p  < 0.05 considered a statistically significant result. Data has been made available via Mendeley ( https://doi.org/10.17632/vf3mf379x5.1 ).\n\nThe mean age of those with endometriosis was 31.46 years (SD = 7.33), while the mean age of those in the control group was 27.81 years (SD = 6.87). Of the 247 participants in the sample with endometriosis, 239 identified as women (97%), while eight identified as non‐binary (3%). Out of the 98 people without endometriosis, 97 identified as women (99%), with one participant identifying as non‐binary (1%). The majority of participants (82%) reported that they had a tertiary qualification (certificate, diploma, bachelor or postgraduate qualification). Of those with endometriosis, 139 participants reported that they had a regular menstrual cycle (56%), with 108 reporting that they did not (44%). Of those without endometriosis, 74 (76%) participants reported a regular menstrual cycle compared to 24 who did not (24%). Both groups reported using a range of contraceptives including the oral contraceptive pill, contraceptive implants or injections, and intrauterine devices (IUD's). 115 participants with a diagnosis of endometriosis reported that they had also been diagnosed with a mental health or neurodevelopmental condition (47%), while 23 participants without endometriosis reported the same (23%; see Table  1  for detailed breakdown of mental health and neurodevelopmental diagnoses). 61 people diagnosed with endometriosis also reported at least one comorbid chronic pain condition (25%; see Table  2  for a detailed breakdown of comorbid chronic pain conditions). Varying pain intensity was reported across the four measures of dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain; see Table  3  for further detail. The mean length of time since participants initially received a diagnosis of endometriosis was 63.46 months (SD = 64.81, range = 1–305 months).\nMental health and neurodevelopmental disorder diagnoses.\nComorbid chronic pain conditions in endometriosis group.\nNote: \n N  = 61. Frequencies represent responses for each pain‐type as participants could report multiple conditions. Therefore, frequencies will not correspond with the total sample size. All responses classified as nociplastic pain refer to a diagnosis of fibromyalgia.\nPain intensity in individuals with endometriosis.\nThe final regression models, which included predictors of age, mental health or neurodevelopmental disorder diagnosis, and endometriosis diagnosis, significantly predicted scores in the Noticing, Not Distracting, Not Worrying, Attention Regulation, Self‐Regulation, and Trusting subscales. The final models were not predictive for either the Emotional Awareness or Body Listening subscales. A significant amount of unique variance in Noticing, Not Distracting, Not Worrying, and Trusting was explained through the addition of endometriosis diagnosis in step 2 of the model. However, endometriosis diagnosis did not explain a significant amount of unique variance for the Attention Regulation, Emotional Awareness, Self‐Regulation, and Body Listening subscales.\nThese results indicate that individuals with endometriosis have higher scores on the Noticing subscale of the MAIA‐2 than those who have not been diagnosed with the condition, while also scoring lower than those without a diagnosis of the condition on the Not Distracting, Not Worrying, and Trusting subscales. There was no observed difference between those with and without a diagnosis of endometriosis on the Attention Regulation, Emotional Awareness, Self‐Regulation, and Body Listening subscales. In all instances, small effect sizes were found (Wall Emerson  2023 ), with  R \n 2  statistics ranging from 0.000 (Self‐Regulation and Body Listening subscales) to 0.041 (Not Distracting Subscale). Means and standard deviations across MAIA subscales are reported in Table  4 . See Table  5  for full regression models.\nScores on MAIA subscales for individuals with and without endometriosis.\nResults of regression models predicting MAIA subscales from endometriosis diagnosis.\nAbbreviation: MH/ND Diagnosis, mental health or neurodevelopmental condition diagnosis.\np  < 0.05.\np  < 0.01.\np  < 0.001.\nThe final regression model indicated that age, mental health or neurodevelopmental disorder diagnosis, dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain were together significant predictors of scores in the Noticing, Not Worrying, and Trusting subscales. The addition of dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain in step 2 of the model represented a statistically significant improvement of the model for the Noticing subscale. This indicates that higher pain intensity is predictive of higher scores in the Noticing subscale in those with endometriosis, with the final model explaining 7% of the variance in scores. There was no statistically significant change when pain intensity was added in step 2 of the models for Not Distracting, Not Worrying, and Trusting, indicating that pain intensity is not predictive of scores in these subscales. See Table  6  for full regression models.\nResults of regression models predicting MAIA subscales from pain intensity in endometriosis group.\nAbbreviations: CPP, chronic pelvic pain; MH/ND Diagnosis, mental health or neurodevelopmental condition diagnosis.\np  < 0.05.\np  < 0.01.\np  < 0.001.\n\nIn this study we aimed to investigate differences in interoceptive beliefs between those with a confirmed diagnosis of endometriosis and those without. Our results indicate that those with endometriosis notice more interoceptive cues than those without endometriosis. Participants with endometriosis also reported a tendency to distract themselves more from interoceptive sensations, while being more worried by these sensations and having less trust in their interoceptive cues. With regards to our secondary aim, we found that average pain intensity over the previous four weeks positively predicted how much people with endometriosis noticed interoceptive sensations. However, pain intensity did not predict how much people with endometriosis distracted themselves from interoceptive cues, worried about these cues or trusted their bodies.\nOur findings of differences in interoceptive beliefs in those with endometriosis are partially consistent with previous research in endometriosis populations (Cantoni et al.  2025 ; Pasternack et al.  2025 ) and echo findings from chronic pain populations more broadly. While Pasternack et al. ( 2025 ) found that individuals with endometriosis scored lower on all subscales of the MAIA, we only found differences in the Noticing, Not Distracting, Not Worrying, and Trusting subscales. Additionally, we found that those with endometriosis scored higher on the Noticing subscale compared to Pasternack et al. ( 2025 ) who found they scored lower. It is difficult to explain these different findings, as Pasternack et al. ( 2025 ) had limited reporting of their results and did not present specific results for individual subscales. On a broader level, our results are largely consistent with those found in chronic pain populations. Our findings of increases in noticing internal sensations, combined with decreases in not worrying, not distracting, and trusting, are consistent with research reporting that those with chronic pain are more aware of internal sensations, more distressed by these sensations, and trust their bodies less (Horsburgh et al.  2024 ). This consistency with previous research in chronic pain populations suggests that alterations in interoceptive beliefs may be a transdiagnostic characteristic in conditions marked by pain.\nAn examination of the factor structure of the MAIA can provide insights into our findings of inconsistent differences in interoceptive beliefs in those with endometriosis. When the MAIA was originally developed by Mehling et al. ( 2012 ), they proposed a conceptual framework of five dimensions of interoceptive beliefs. These initial five dimensions were then split into the eight subscales used in the questionnaire based on exploratory and confirmatory factor analysis. A recent study aiming to create an interoceptive profile of individuals with chronic pain also proposed a similar five‐factor structure for the MAIA, based on independent factor analysis (Oliveira et al.  2024 ). Of these proposed five dimensions, we identified differences between those with and without endometriosis on three, including Awareness of Body Sensations (encompassing the Noticing subscale), Emotional Reaction and Attentional Response to Sensations (encompassing the Not Distracting and Not Worrying subscales), and Trusting Body Sensations (encompassing the Trusting subscale; Mehling et al.  2012 ; Oliveira et al.  2024 ). Our findings indicate that those with endometriosis do not differ on the remaining two dimensions of Capacity to Regulate Attention (encompassing the Attention Regulation subscale) and Awareness of Mind–Body Integration (encompassing the Emotional Awareness, Self‐Regulation, and Body Listening subscales; Mehling et al.  2012 ; Oliveira et al.  2024 ). When viewed through the lens of these higher‐order categories, our results suggest that those with endometriosis are more aware of their internal sensations, with stronger emotional responses to these signals and are less trusting of internal signals.\nOur findings of differences in sensory appraisal in those with endometriosis may be reflective of the predictions of the fear avoidance model applied in chronic pain (Vlaeyen and Linton  2000 ,  2012 ). Specifically, according to the fear avoidance model, those with chronic pain display hypervigilance toward potential threats and experience increased fear of pain, which contributes to avoidant behaviour (Vlaeyen and Linton  2012 ). Our finding that people with endometriosis report noticing more internal sensations may reflect an underlying mechanism that promotes hypervigilance to potential threats. Similarly, stronger emotional reactions to interoceptive sensations as evidenced by lower scores in the Not Worrying and Trusting subscales may reflect increased fear of pain, while lower scores in the Not Worrying subscale may be indicative of higher pain catastrophising (Park et al.  2021 ). Finally, those with endometriosis reported that they distracted themselves more from internal sensations, which may be indicative of avoidant behaviour. The interaction between interoceptive beliefs and fear avoidance should be further explored as this could offer opportunities for interventions that recalibrate attention and appraisal of bodily sensations alongside standard pain management.\nOur investigation of pain symptoms suggests an interaction between these symptoms and interoception in those with endometriosis. We found those with more intense dysmenorrhea, dyschezia, dyspareunia, and chronic pelvic pain reported that they noticed more interoceptive signals. However, pain intensity was not predictive of participants' tendency to distract from bodily sensations, worry about bodily sensations, or trust their bodily sensations. Previous individual studies have found correlations between pain intensity and interoceptive abilities in a range of painful conditions (Borg et al.  2018 ; Ciaramella et al.  2023 ; Kirdi et al.  2022 ; Rost et al.  2017 ), but larger scale reviews have been unable to find a consistent relationship between interoception and pain intensity (Horsburgh et al.  2024 ). This may be due to the heterogeneity of results found and measures used in previous research, with both positive (Kirdi et al.  2022 ; Rost et al.  2017 ) and negative (Borg et al.  2018 ; Ciaramella et al.  2023 ) correlations found across a range of measures, including the MAIA and the Body Awareness Questionnaire. Our findings extend on previous research by investigating the link between pain and interoception in a unique population and further emphasise the complex and nuanced nature of the relationship between interoceptive beliefs and pain intensity.\nWhen considered together, our findings point to the interoceptive consequences of endometriosis. Our analyses indicate that of the interoceptive subscales found to differ between those with and without endometriosis, pain symptoms predicted only the Noticing subscale. This subscale was also the only subscale where individuals with endometriosis scored higher than controls in the primary analysis. Increased detection of interoceptive input in those with endometriosis may then be driven by pain, whereas decreases in affective and cognitive responses to these inputs may be attributed to other aspects of the disease such as delayed diagnosis (Agarwal et al.  2019 ) and affective changes (Cavaggioni et al.  2014 ; Facchin et al.  2015 ). While further research is needed to explore the causal interactions between symptoms of endometriosis and the differences in interoceptive beliefs, one possible explanation for the relationship between pain intensity and increased noticing of body sensations in endometriosis is central sensitization. Central sensitization refers to over‐reactivity and hypersensitivity of nociceptors within the central nervous system (Woolf  2011 ). Central sensitization has been found in people diagnosed with a range of conditions marked by pain (Ji et al.  2018 ; Nijs et al.  2019 ), including endometriosis (Bajaj et al.  2003 ; Grundström et al.  2019 ). While speculative, it is possible that the over‐reactivity of nociceptive pathways seen in people who experience central sensitization may generalise to increased sensitivity to interoceptive sensations in those with endometriosis, explaining the higher interoceptive noticing observed in the current study.\nSeveral limitations of this study should be noted. Firstly, there was significant diversity in samples between those diagnosed with endometriosis and the control group. This diversity extended to within‐group differences, with variability in pain levels and mental health or neurodevelopmental disorder diagnoses in the endometriosis group. While we tried to mitigate the effects of this variability by controlling for mental health or neurodevelopmental disorder diagnoses, it may nonetheless affect the level of certainty we can have in our results given the roles that psychopathology and pain may play in the relationship between interoception and endometriosis. However, it should also be noted that this within and between‐group variation reflects the variability of the broader population, with differing levels of pain and higher rates of psychopathology seen in those with endometriosis (Cavaggioni et al.  2014 ; Horne and Missmer  2022 ). Our study also only considered a single domain of interoception, interoceptive beliefs. Interoception is defined as a multidimensional process (Suksasilp and Garfinkel  2022 ), and considering other domains such as interoceptive accuracy would strengthen our understanding of any broader interoceptive changes in those with endometriosis. Our findings should therefore not be considered reflective of all interoceptive capacity. Finally, the use of a cross‐sectional study design limits our ability to make longitudinal predictions about the relationship between interoceptive beliefs and endometriosis. Our results therefore should not be interpreted as providing temporal or causal predictions. The use of cohort studies in the future would allow for a more detailed temporal understanding of the relationships that we have observed.\nThis study aimed to investigate whether there were differences in interoceptive beliefs in those with endometriosis compared to those without. We found that those with endometriosis reported that they noticed more interoceptive signals, had greater tendencies to distract from and worry about these signals, and reported lower trust in their bodies. We also found that people with endometriosis who reported higher pain also reported that they noticed more interoceptive cues. Through this study, we have extended our understanding of the relationship between endometriosis and interoception; however, further research is still needed. Research should aim to develop a multidimensional understanding of potential alterations in interoception in those diagnosed with the condition, while also considering the interactions between the interoception, endometriosis and its symptoms. Additionally, research should consider the efficacy of possible therapeutic approaches, such as mindfulness‐based interventions, to alter interoceptive functioning in those with endometriosis (Evans et al.  2019 ; Moreira et al.  2022 ,  2024 ). Such research may offer insights into the experience of those with endometriosis and avenues for the management of symptoms.\n\nThe study was conceptualised and methodology developed by A.H., A.L., A.N., P.H., C.T., J.M., and A.F. The software was managed by A.N., and A.N. and A.L. contributed to data curation. A.H. completed the statistical analysis and original draft preparation. All authors contributed to reviewing and editing of the manuscript. S.J.S., R.J.K, and A.F. provided supervision throughout the study. Project administration was managed by A.F. All authors have approved the final version of the manuscript.\n\nThis research was supported by an Australian Government Research Training Program (RTP) Scholarship:  10.82133/C42F‐K220 .\n\nThe authors declare no conflicts of interest.\n\nSupporting Information 1:  Results of regression models predicting MAIA subscales from endometriosis diagnosis with outliers excluded.\nSupporting Information 2:  STROBE Statement—Checklist of items that should be included in reports of  cross‐sectional studies .","source_license":"public-domain-us","license_restricted":false}