Early life trauma and endometriosis: a case-control study on type and timing of adverse experiences

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Different risk factors for endometriosis have been proposed, with some research finding a significant relationship between endometriosis and early life trauma. This study aimed to determine the prevalence, age, and type of early life trauma in a clinical sample of women with existing diagnosis of endometriosis compared with the prevalence in the general Australian female population. Methods Participants were recruited from the Multidisciplinary Alfred Psychiatry research centre Women’s Mental Health Clinic (WMHC). Women who self-reported a diagnosis of endometriosis were identified from the WMHC patient database, established in 2017. In patients who reported a presence of early life trauma, information regarding the type and age of the early traumatic experience(s) was recorded. The prevalence of each type of trauma in our participants was compared to the general female population in Australia. Results Of 68 included participants, the mean (SD) age was 41.6 (9.7) years. 86.8% of participants (n = 59) reported experience of any early life trauma, most commonly occurring between ages 6–10 (89.8%). The most reported type of trauma was emotional abuse (76.5%). Compared to the general female population, the prevalence of emotional abuse (76.5% vs 37.3%), neglect (35.3% vs 10.8%), and sexual abuse (39.7% vs 37.3%) were higher in our sample. Conclusion The findings of this study found high prevalence rates of early life trauma, in particular emotional abuse and neglect, in women with endometriosis. Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Endometriosis is a common chronic inflammatory gynaecological condition characterised by the abnormal presence of endometrial tissue outside the uterus, including on the pelvic peritoneum, ovaries, fallopian tubes, and rectovaginal septum. There is an estimated 6–10% prevalence of pelvic endometriosis in the general female population (Houston 1984 ), increasing to 35–50% in women with one or both symptoms of pain and infertility (Wheeler 1989 ). The precise aetiology of endometriosis remains unclear, as well as an explanation as to why some women are affected by endometriosis while others are not. Current models theorise a ‘two-stage’ pathogenic process of endometriosis involving menstrual reflux as the initiating factor, followed by hormonal activity, impaired immunological response, and inflammation promoting the implantation of extrauterine endometrial cells (Parazzini et al. 2017 ). Different risk factors for endometriosis have also been proposed, with some recent research demonstrating a significant relationship between endometriosis and early life trauma (Harris et al. 2018 ;Liebermann et al. 2018 ). The World Health Organization (WHO) classifies four types of childhood trauma: physical abuse, emotional abuse, sexual abuse, and neglect (Butchart 2006 ). Studies have previously established a link between exposure to childhood maltreatment and the development of physical disorders (Clemens et al. 2018 ), and in female populations, adverse childhood experiences are related to an increased risk of polycystic ovary syndrome (Mu et al. 2024 ), including correlation of sexual abuse with several other gynaecological issues including pelvic floor dysfunction, dyspareunia, and irregular menses (Vézina-Gagnon et al. 2018 ). Research investigating the role of early life trauma in endometriosis is limited. In a large prospective cohort study, Harris et al. ( 2018 ) found that the risk of laparoscopically-confirmed endometriosis was greater among women reporting severe physical or sexual abuse compared to those reporting no prior history, and a 79% increased risk of endometriosis for women who experienced chronic-severe abuse of multiple types. Liebermann et al. ( 2018 ) found the risk of endometriosis was greater among participants with a history of emotional abuse, sexual abuse, neglect, and inconsistent experiences, with the greatest difference observed for emotional abuse. Conversely, of the different types of abuse, Tietjen et al. ( 2010 ) found a significant association only with physical abuse, with 15% of participants with endometriosis reporting exposure to physical abuse. Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is a hypothesised pathological mechanism linked to early life trauma (Westfall & Nemeroff 2015 ). The HPA axis is a dynamic feedback pathway that regulates cortisol secretion through a cascade of events triggered by stress responses in the body. In chronic stress, such as exposure to trauma, there is overactivity of the HPA axis and excess cortisol production as a consequence of altered central nervous system corticotropin-releasing hormone circuits (Heim et al. 2010 ). These enduring neuroendocrine changes may lead to the development of health complications such as autoimmune disease (Song et al. 2018 ), coronary heart disease (Wirtz & von Känel 2017 ), and polycystic ovarian syndrome (Mu et al. 2024 ). A study by Kuhlman et al. ( 2015 ) also found differences in physiological outcomes depending on the timing of trauma, with exposure to trauma during infancy related to acute stress dysregulation versus circadian cortisol dysregulation in later trauma exposure. This case control study aims to address the limited research on the relationship between endometriosis and early life trauma. We focus on evaluating the prevalence of childhood trauma in a clinical sample of women with existing diagnosis of endometriosis compared with the prevalence of early life trauma in the general Australian female population, and the relevance of type and age of early life trauma experience. We hypothesise that the prevalence of early life trauma is higher in women with endometriosis than in the general female Australian population, and that certain ages and types of trauma experience are more prevalent than others. 2. Materials and Methods 2.1. Participant recruitment Participants were recruited from the Multidisciplinary Alfred Psychiatry research centre (MAPrc) Women’s Mental Health Clinic (WMHC), a public service providing specialist secondary consultation for women referred with complex psychiatric concerns. Written informed consent was obtained from patients for their demographic and clinical information to be entered into the WMHC research database. Information on demographics, medical and psychiatric history, and retrospective developmental history, including experience of early life trauma, was collected via clinician-administered patient interviews. The study was approved by the Alfred Health Human Research Ethics Committee (Project 285/17) and registered with the Monash University Human Research Ethics Committee (Project #25557). 2.2. Data collection The WMHC database was searched for all patients who attended the WMHC from 2017 to October 2024, and women who self-reported a diagnosis of endometriosis were identified. The experience of early life trauma, specifically neglect, emotional, physical or sexual abuse, was determined by experienced clinicians informed by a scale developed by MAPrc. In patients who reported a presence of early life trauma, information regarding the type and age of the early traumatic experience(s) was recorded. Type of trauma was classified as: emotional abuse, physical abuse, neglect, or sexual abuse. Age of trauma experience was classified by fixed age groups: 0–5, 6–10, 11–14, and 15–18 years. 2.3. Statistical analysis Demographic and clinical variables were summarised using descriptive statistics. Frequency counts and proportions were used to calculate the overall prevalence of early life trauma within the sample of women with endometriosis, as well as the specific type of unique or co-occurring abuse experienced. The prevalence of emotional abuse, physical abuse, neglect, and sexual abuse in our participants was firstly compared to our total cohort of women with endometriosis, and secondly to the general female population in Australia, derived from the Australian Child Maltreatment Study (Mathews et al. 2023 ). Significance was determined using the χ 2 statistic for categorical variables. The unadjusted odds ratio (OR) and accompanying 95% confidence interval (CI) were estimated for the types of trauma and age groups, with the 0–5 years group used as a reference group in all comparisons. OR was also employed in sensitivity analysis to explore the differences of prevalence across age groups in physical or mental health conditions. Statistical analysis was performed using R (Version 4.2.2, https://www.r-project.org/ ), and the figures were made in GraphPad Prism version 10.0 (GraphPad Software, Boston, Massachusetts USA, www.graphpad.com ). Statistical significance was set at a p value of < 0.05. 3. Results 3.1. Participant characteristics The demographic and clinical characteristics of our sample of women with endometriosis ( N = 68) are summarised in Table 1 . The mean age of participants was 41.6 years (SD = 9.68), with age range of 23–64 years. The majority of women (42.6%) were in their reproductive years, followed by perimenopause (32.4%). Four participants (5.9%) were pregnant at the time of the clinic visit. Eleven participants (16.2%) had previously undergone a hysterectomy. All women in our sample had received at least one mental health diagnosis currently or in the past, with the highest prevalences seen in complex trauma disorder (70.6%), major depressive disorder (63.2%), and premenstrual dysphoric disorder (48.5%). The most common comorbid physical health conditions were polycystic ovarian syndrome, chronic fatigue syndrome, fibromyalgia, and autoimmune disease (19.1%). Table 1 Demographic and clinical characteristics for women with endometriosis ( N = 68) Mean age in years [SD], range N (%) 41.6 [9.68], 23–64 Employment None/Studying 19 (27.9) Casual 3 (4.4) Part-time 16 (23.5) Full-time 19 (27.9) Missing 11 (16.2) Highest education completed Year 11–12 5 (7.4) Vocational training (TAFE, diploma) 13 (19.1) Bachelor’s degree 23 (33.8) Postgraduate degree 17 (25) Missing 10 (14.7) Alcohol use No current use 15 (22.1) Infrequent or monthly 23 (33.8) Daily or almost daily 9 (13.2) Missing 21 (30.9) Cigarette use Non-smoker 27 (39.7) Current 6 (8.8) Past smoker 14 (20.6) Missing 21 (30.9) Illicit substance use Never 23 (33.8) Current 6 (8.8) Past 18 (26.5) Missing 21 (30.9) Reproductive state Reproductive 29 (42.6) Pregnant 4 (5.9) Perimenopause 22 (32.4) Post-menopause (natural) 5 (7.4) Post-menopause (surgical) 8 (11.8) Previous hysterectomy 11 (16.2) Mental health diagnoses † Any 68 (100) Major depressive disorder 43 (63.2) Perimenopausal depression 22 (32.4) Premenstrual dysphoric disorder 33 (48.5) Generalised anxiety disorder 27 (39.7) Complex trauma disorder 48 (70.6) Other psychiatric condition 38 (55.9) Physical health diagnoses † Hyperlipidaemia 10 (14.7) Polycystic ovarian syndrome 13 (19.1) Chronic fatigue syndrome 13 (19.1) Fibromyalgia 13 (19.1) Irritable bowel syndrome 10 (14.7) Autoimmune condition 13 (19.1) Other physical condition 42 (61.8) † Some participants were diagnosed with > 1 condition; N, number of participant; SD, standard deviation. 3.2. Prevalence of early life trauma (type) A high proportion of our sample of women with endometriosis experienced early life trauma, with 86.8% ( n = 59) reporting a history of at least one of emotional abuse, physical abuse, neglect, or sexual abuse. Most women with a history of early life trauma experienced one type of trauma alone (35.3%), and emotional abuse was the type of trauma most commonly reported (76.5%). These findings are summarised in Table 2 . Table 2 Prevalences and ages of early life trauma ( N = 68) Any experience of early life trauma † Total, N (%) Comparative test 59 (86.8) Number of types of trauma experienced † None 8 (11.8) 1 24 (35.3) 2 18 (26.5) > 3 18 (26.5) Age of abuse experienced ( N = 59) † 0–5 years old 42 (71.2) 6–10 years old 51 (86.4) 11–14 years old 49 (83.1) 15–18 years old 42 (71.2) Experience of trauma throughout childhood (all age groups 0–18 years old) 30 (44.1) χ 2 = 6.3, p = 0.012 Emotional abuse 52 (76.5) 0–5 years old 38 (73.1) χ 2 = 23.6, p < 0.001 6–10 years old 46 (88.5) χ 2 = 39.8, p < 0.001 11–14 years old 46 (88.5) χ 2 = 39.8, p < 0.001 15–18 years old 37 (71.2) χ 2 = 22.2, p < 0.001 Physical abuse 18 (26.5) 0–5 years old 8 (44.4) χ 2 = 21.1, p < 0.001 6–10 years old 13 (72.2) χ 2 = 40.10, p < 0.001 11–14 years old 12 (66.7) χ 2 = 36.02, p < 0.001 15–18 years old 9 (50) χ 2 = 24.6, p < 0.001 Neglect 24 (35.3) 0–5 years old 17 (70.8) χ 2 = 37.9, p < 0.001 6–10 years old 20 (83.3) χ 2 = 48.0, p < 0.001 11–14 years old 20 (83.3) χ 2 = 48.0, p < 0.001 15–18 years old 19 (79.2) χ 2 = 44.5, p < 0.001 Sexual abuse 27 (39.7) 0–5 years old 8 (29.6) χ 2 = 11.0, p < 0.001 6–10 years old 15 (55.6) χ 2 = 26.1, p < 0.001 11–14 years old 11 (40.7) χ 2 = 17.0, p < 0.001 15–18 years old 13 (48.1) χ 2 = 21.39, p < 0.001 † Comparative analysis was not completed for Any experience of early life trauma , Number of types of early life trauma experienced , and Age of abuse experienced ; N , number of participants; p , p value 3.3. Prevalence of early life trauma (age) Early life trauma was experienced throughout childhood across all four age groups (0–5, 6–10, 11–14, 15–18) for 44.1% of participants. 9 participants (13.2%) reported early life trauma limited within a single age category. Of the 59 participants reporting early life trauma, the age range at which this was most frequently experienced was 6–10 years of age (86.4%), closely followed by 11–14 years (83.1%). These findings are summarised in Figs. 1 and 2 . In the sensitivity analysis, the prevalence of emotional abuse in 6–10 years group and 11–14 years group were significantly higher than in the reference group ( p = 0.03 and p = 0.03, respectively) in the population with generalized anxiety disorder as presented in the supplementary table (Online Resource 1). 3.4. Comparison with general population The prevalence of early life trauma in our sample of women with endometriosis was greater compared to the general Australian female population (Mathews et al. 2023 ) for emotional abuse, sexual abuse, and neglect (Fig. 3 ) . Compared to the general population, the prevalences of emotional abuse and neglect were significantly greater in our sample by 39.2% ( p < 0.001) and 24.5% ( p < 0.001), respectively (Fig. 4 ). Sexual abuse was greater in our sample by 2.4% but not significantly different. Conversely, the prevalence of physical abuse was lower in our sample compared to the general female Australian population by 5%. 4. Discussion The primary aim of this study was to investigate whether the prevalence of childhood trauma in a clinical sample of women with endometriosis was higher compared to the general Australian female population. The secondary aim was to evaluate the relevance of age and type of early life trauma experience in this cohort. 4.1. Prevalence of trauma Our study found a high prevalence of trauma in women with endometriosis, with 86.8% of participants reporting experiencing childhood trauma. This finding is supported by the HPA axis model linking stress with excess cortisol production and neuroendocrine changes (Westfall & Nemeroff 2015 ). In particular, long-term consequences of repeated exposure to early life stress include downstream effects of HPA axis dysfunction, including immune dysregulation and compromised reproductive health, both pathophysiological features of endometriosis (Abramiuk et al. 2022 ;Neigh et al. 2009 ). Past studies also support early life trauma as having a role in chronic inflammation (Grewal et al. 2024 ). Bertone-Johnson et al. ( 2014 ) found that women who reported childhood sexual abuse had higher plasma levels of interleukin-6 and C-reactive protein than those who did not, suggesting that early life abuse may contribute to chronic inflammation through dysregulated immune function. Moreover, Kerr et al. ( 2021 ) established a significant association between early life trauma and increased inflammation when compared to controls without past exposure to trauma. This is potentially important when considering inflammation as a pathogenic hallmark of endometriosis, explained by mechanisms of peritoneal macrophage infiltration and local proinflammatory mediators (Parazzini et al. 2017 ;Wu et al. 2015 ). Epidemiologically, these findings may be linked to the overall comparatively higher prevalence of early life trauma observed in our endometriosis sample. 4.2. Type of trauma Our results showed prevalence rates of different types of childhood trauma ranging from 26.5% to 76.5%. There was a significantly higher prevalence of early life emotional abuse and neglect in women with endometriosis compared to the general female population, suggesting that women with endometriosis are more likely to have experienced these specific types of early life trauma. Our findings are consistent with Liebermann et al. ( 2018 ), who found that childhood emotional abuse and neglect were significantly associated with endometriosis. The lower prevalences of physical and sexual abuse observed in our cohort are also in line with studies by Schliep et al. ( 2016 ), however, they contrast with the findings of Tietjen et al. ( 2010 ), who found significant associations with physical abuse, sexual abuse, and emotional abuse. The significant downstream impacts following emotional abuse and neglect in early life may be due to a variety of mechanisms. Existing literature has suggested that childhood emotional abuse is the most harmful type of early life trauma for children (Gibb 2002 ). In these instances, this may be due to the caregiving role the perpetrator typically holds in relation to the victim, which involves a violation of the love and respect usually expected (Kulkarni et al. 2022 ). Emotional abuse also tends to be more verbal, enabling greater internalisation of negative self-perceptions in the victim (Sachs-Ericsson et al. 2006 ). 4.3. Age of trauma Overall, across all types of trauma, childhood trauma occurring between the ages of 6–10 and 16–14 was more common than other age groups at prevalences of 86.4% and 83.1%, respectively. This may reflect the age-dependent neurobiological developmental processes in which rapid brain changes are observed in specific developmentally sensitive periods of childhood (Thomas et al. 2019 ). Trauma in early life may also be more harmful than trauma experienced later in life, as it interferes with a child’s ability to effectively navigate critical developmental milestones, such as forming secure attachments and self-regulation (Dunn et al. 2017 ). Similarly, Jean Piaget’s theory of cognitive development also represents middle childhood as a critical period for shifts in egocentrism and mentalisation (Piaget 1971 ). We found that 44.1% of women experienced early life trauma throughout childhood, between the ages 0–18. This finding reflects a high prevalence of chronic early life trauma in our sample of women with endometriosis. In comparison, only 13.2% of participants experienced trauma within an isolated age group. This may suggest that prolonged exposure to trauma throughout childhood is more strongly associated with endometriosis rather than a specific age of exposure. 4.4. Limitations and implications Several limitations need to be taken into consideration. Firstly, there was inherent sampling bias in our participant group, given our participants were recruited from a specialist consultation clinic for women with complex psychiatric concerns, therefore impacting generalisability to the general female population. The data from this study were obtained cross-sectionally from participants’ retrospective self-reports, thus enabling a degree of recall bias. As such, it is possible that childhood trauma occurring in the 0–5 age group was also underreported. Moreover, although trauma history was ascertained through clinical interview by experienced clinicians, this was not carried out through standardised methods of assessing trauma, for example, through a validated questionnaire or survey. However, it should be noted that there has been a high convergent validity between self-report questionnaires and comprehensive interviews (Gayer-Anderson et al. 2020 ). Finally, there was no healthy control group to compare trauma characteristics and prevalence with our endometriosis sample. Instead, prevalence figures of the general female Australian population were utilised as a point of comparison. As a result, descriptive comparisons of participant demographic characteristics and age of trauma were unable to be undertaken. While some previous research has investigated the prevalence of trauma in individuals with endometriosis (Harris et al. 2018 ;Liebermann et al. 2018 ;Tietjen et al. 2010 ), to our knowledge, this is the first study to explore the ages at which trauma was experienced. Our study also indicates a need for further research investigating emotional abuse and neglect specifically, given these types of trauma are generally less studied than physical and sexual abuse (Harris et al. 2018 ;Schliep et al. 2016 ;Tietjen et al. 2010 ). Our findings suggest a significant difference may exist between certain types and ages of childhood trauma and the development of endometriosis. By identifying high prevalence rates of early life trauma in women with endometriosis, our findings support the importance of assessing prior trauma when obtaining a comprehensive clinical history in patients with endometriosis. Likewise, targeted screening for trauma and specific abuse profiles may assist clinicians in identifying individuals at higher risk of developing endometriosis. A focus on effective prevention and intervention of early life trauma is likely essential to mitigate the many long-term health consequences and other downstream effects of trauma that can arise. 5. Conclusion Our cohort of women with endometriosis had a significantly higher prevalence of early life emotional abuse and neglect compared to the general Australian population. Additionally, prolonged exposure to trauma throughout childhood may increase the risk of developing endometriosis. Our study contributes to understandings of the relationship between early life trauma and endometriosis. More research is necessary to further characterise this relationship in future studies. Declarations Clinical trial number: not applicable. Funding: this research received no external funding. 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Neuropsychiatr Dis Treat , 15 , 2601-2612. https://doi.org/10.2147/ndt.S198804 Tietjen, G. E., Brandes, J. L., Peterlin, B. L., Eloff, A., Dafer, R. M., Stein, M. R., Drexler, E., Martin, V. T., Hutchinson, S., Aurora, S. K., Recober, A., Herial, N. A., Utley, C., White, L., & Khuder, S. A. (2010). Childhood Maltreatment and Migraine (Part III). Association With Comorbid Pain Conditions. Headache: The Journal of Head and Face Pain , 50 (1), 42-51. https://doi.org/https://doi.org/10.1111/j.1526-4610.2009.01558.x Vézina-Gagnon, P., Bergeron, S., Frappier, J.-Y., & Daigneault, I. (2018). Genitourinary Health of Sexually Abused Girls and Boys: A Matched-Cohort Study. The Journal of Pediatrics , 194 , 171-176. https://doi.org/https://doi.org/10.1016/j.jpeds.2017.09.087 Westfall, N. C., & Nemeroff, C. B. (2015). The Preeminence of Early Life Trauma as a Risk Factor for Worsened Long-Term Health Outcomes in Women [Review]. Current Psychiatry Reports , 17 (11), Article 90. https://doi.org/10.1007/s11920-015-0625-6 Wheeler, J. M. (1989). Epidemiology of endometriosis-associated infertility. J Reprod Med , 34 (1), 41-46. Wirtz, P. H., & von Känel, R. (2017). Psychological Stress, Inflammation, and Coronary Heart Disease [Review]. Current Cardiology Reports , 19 (11), Article 111. https://doi.org/10.1007/s11886-017-0919-x Wu, M.-H., Hsiao, K.-Y., & Tsai, S.-J. (2015). Endometriosis and possible inflammation markers. Gynecology and Minimally Invasive Therapy , 4 (3), 61-67. https://doi.org/https://doi.org/10.1016/j.gmit.2015.05.001 Additional Declarations No competing interests reported. Supplementary Files ESM1.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9496409","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639564247,"identity":"b0925a1c-aad2-4ab1-b17c-c3c4876a62c3","order_by":0,"name":"Lauren Chiu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYBACPhjDgJmB8QGYJQHEPHi0sCFpYTYgUQuQLUGcFvYzZh8+7mCQN2fnMau6UXFHXn52A+ODt214tPDkGM+ceYbBcGczj9ntnDPPDDfcOcBsOBefFoYcY2beNoYEg8NALblthxk3SCSwSfPi08L/xpj5L1RLMVCL/fwZCey/8WqRANrCCNXCDNSS2HAjgY0Zv5ZnxYy9bRKGGw6zFUvnnDmcvOFGYrPknHO4tfDzJ29m+NlmI29w/vDGzzkVh23nz0g++OFNGW4tUCCBzGFsIKh+FIyCUTAKRgF+AAC63klFVFZ1cAAAAABJRU5ErkJggg==","orcid":"","institution":"Multidisciplinary Alfred Psychiatry research centre","correspondingAuthor":true,"prefix":"","firstName":"Lauren","middleName":"","lastName":"Chiu","suffix":""},{"id":639564248,"identity":"340d62d9-ff32-498c-bf18-d5100e66263b","order_by":1,"name":"Eveline Mu","email":"","orcid":"","institution":"Multidisciplinary Alfred Psychiatry research centre","correspondingAuthor":false,"prefix":"","firstName":"Eveline","middleName":"","lastName":"Mu","suffix":""},{"id":639564252,"identity":"cdf79b2e-a351-45c1-a34f-71b0ad2a498c","order_by":2,"name":"Qi Li","email":"","orcid":"","institution":"Multidisciplinary Alfred Psychiatry research centre","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Li","suffix":""},{"id":639564253,"identity":"d4c05c2d-65a5-4e46-b337-41d3e0b350c9","order_by":3,"name":"Lucy Ingleby","email":"","orcid":"","institution":"Multidisciplinary Alfred Psychiatry research centre","correspondingAuthor":false,"prefix":"","firstName":"Lucy","middleName":"","lastName":"Ingleby","suffix":""},{"id":639564257,"identity":"d58f3d33-1c67-43b4-93b7-2d49dfd9a8d6","order_by":4,"name":"Jayashri Kulkarni","email":"","orcid":"","institution":"Multidisciplinary Alfred Psychiatry research centre","correspondingAuthor":false,"prefix":"","firstName":"Jayashri","middleName":"","lastName":"Kulkarni","suffix":""}],"badges":[],"createdAt":"2026-04-22 12:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9496409/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9496409/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109521106,"identity":"3d860b09-1da4-4b7e-8d26-cac78e60f4e3","added_by":"auto","created_at":"2026-05-19 06:25:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49947,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot comparing the prevalence of age groups at which early life trauma was experienced\u003c/p\u003e\n\u003cp\u003eOR, odds ratio; CI, confidence interval; REF, reference group for group comparison\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9496409/v1/a5279b0df865edcbef51d62c.png"},{"id":109521292,"identity":"68f135f8-e402-4123-a1f1-32c5068494f3","added_by":"auto","created_at":"2026-05-19 06:26:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":83346,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot comparing the prevalence of age groups by trauma type\u003c/p\u003e\n\u003cp\u003eOR, odds ratio; CI, confidence interval; REF, reference group for group comparison\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9496409/v1/1df746d10509383d01d65a8f.png"},{"id":109521363,"identity":"2dbf1520-646c-4a09-8525-1bc64fd31b1d","added_by":"auto","created_at":"2026-05-19 06:26:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":65208,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of early life trauma experience by type, in women with endometriosis compared to the general female Australian population\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9496409/v1/ac5675493101c6e7a86d8f08.png"},{"id":109521109,"identity":"cfb49ebd-4a0a-4b93-9351-bbf65dd07da6","added_by":"auto","created_at":"2026-05-19 06:25:36","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":47038,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot comparing history of trauma in women with endometriosis to the general female Australian population, by type of trauma\u003c/p\u003e\n\u003cp\u003eOR, odds ratio; CI, confidence interval\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9496409/v1/a22f15181ac90ede56b4437d.png"},{"id":109521540,"identity":"98799503-56df-4375-9bbd-d9f5ef422ce4","added_by":"auto","created_at":"2026-05-19 06:26:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":497378,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9496409/v1/9b73e9c2-df14-4570-b363-1ea9a2491209.pdf"},{"id":109521108,"identity":"0318f079-26e7-4196-b84c-4449192525ba","added_by":"auto","created_at":"2026-05-19 06:25:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":99762,"visible":true,"origin":"","legend":"","description":"","filename":"ESM1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9496409/v1/ec2f7d41ea9b2b978ef780e2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Early life trauma and endometriosis: a case-control study on type and timing of adverse experiences","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eEndometriosis is a common chronic inflammatory gynaecological condition characterised by the abnormal presence of endometrial tissue outside the uterus, including on the pelvic peritoneum, ovaries, fallopian tubes, and rectovaginal septum. There is an estimated 6\u0026ndash;10% prevalence of pelvic endometriosis in the general female population (Houston \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e1984\u003c/span\u003e), increasing to 35\u0026ndash;50% in women with one or both symptoms of pain and infertility (Wheeler \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1989\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe precise aetiology of endometriosis remains unclear, as well as an explanation as to why some women are affected by endometriosis while others are not. Current models theorise a \u0026lsquo;two-stage\u0026rsquo; pathogenic process of endometriosis involving menstrual reflux as the initiating factor, followed by hormonal activity, impaired immunological response, and inflammation promoting the implantation of extrauterine endometrial cells (Parazzini et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Different risk factors for endometriosis have also been proposed, with some recent research demonstrating a significant relationship between endometriosis and early life trauma (Harris et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e;Liebermann et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) classifies four types of childhood trauma: physical abuse, emotional abuse, sexual abuse, and neglect (Butchart \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Studies have previously established a link between exposure to childhood maltreatment and the development of physical disorders (Clemens et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), and in female populations, adverse childhood experiences are related to an increased risk of polycystic ovary syndrome (Mu et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), including correlation of sexual abuse with several other gynaecological issues including pelvic floor dysfunction, dyspareunia, and irregular menses (V\u0026eacute;zina-Gagnon et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch investigating the role of early life trauma in endometriosis is limited. In a large prospective cohort study, Harris et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found that the risk of laparoscopically-confirmed endometriosis was greater among women reporting severe physical or sexual abuse compared to those reporting no prior history, and a 79% increased risk of endometriosis for women who experienced chronic-severe abuse of multiple types. Liebermann et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found the risk of endometriosis was greater among participants with a history of emotional abuse, sexual abuse, neglect, and inconsistent experiences, with the greatest difference observed for emotional abuse. Conversely, of the different types of abuse, Tietjen et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) found a significant association only with physical abuse, with 15% of participants with endometriosis reporting exposure to physical abuse.\u003c/p\u003e \u003cp\u003eDysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is a hypothesised pathological mechanism linked to early life trauma (Westfall \u0026amp; Nemeroff \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The HPA axis is a dynamic feedback pathway that regulates cortisol secretion through a cascade of events triggered by stress responses in the body. In chronic stress, such as exposure to trauma, there is overactivity of the HPA axis and excess cortisol production as a consequence of altered central nervous system corticotropin-releasing hormone circuits (Heim et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). These enduring neuroendocrine changes may lead to the development of health complications such as autoimmune disease (Song et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), coronary heart disease (Wirtz \u0026amp; von K\u0026auml;nel \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), and polycystic ovarian syndrome (Mu et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). A study by Kuhlman et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) also found differences in physiological outcomes depending on the timing of trauma, with exposure to trauma during infancy related to acute stress dysregulation versus circadian cortisol dysregulation in later trauma exposure.\u003c/p\u003e \u003cp\u003eThis case control study aims to address the limited research on the relationship between endometriosis and early life trauma. We focus on evaluating the prevalence of childhood trauma in a clinical sample of women with existing diagnosis of endometriosis compared with the prevalence of early life trauma in the general Australian female population, and the relevance of type and age of early life trauma experience. We hypothesise that the prevalence of early life trauma is higher in women with endometriosis than in the general female Australian population, and that certain ages and types of trauma experience are more prevalent than others.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003e2.1. Participant recruitment\u003c/h2\u003e\n \u003cp\u003eParticipants were recruited from the Multidisciplinary Alfred Psychiatry research centre (MAPrc) Women\u0026rsquo;s Mental Health Clinic (WMHC), a public service providing specialist secondary consultation for women referred with complex psychiatric concerns. Written informed consent was obtained from patients for their demographic and clinical information to be entered into the WMHC research database. Information on demographics, medical and psychiatric history, and retrospective developmental history, including experience of early life trauma, was collected via clinician-administered patient interviews. The study was approved by the Alfred Health Human Research Ethics Committee (Project 285/17) and registered with the Monash University Human Research Ethics Committee (Project #25557).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\"\u003e\n \u003ch2\u003e2.2. Data collection\u003c/h2\u003e\n \u003cp\u003eThe WMHC database was searched for all patients who attended the WMHC from 2017 to October 2024, and women who self-reported a diagnosis of endometriosis were identified. The experience of early life trauma, specifically neglect, emotional, physical or sexual abuse, was determined by experienced clinicians informed by a scale developed by MAPrc. In patients who reported a presence of early life trauma, information regarding the type and age of the early traumatic experience(s) was recorded. Type of trauma was classified as: emotional abuse, physical abuse, neglect, or sexual abuse. Age of trauma experience was classified by fixed age groups: 0\u0026ndash;5, 6\u0026ndash;10, 11\u0026ndash;14, and 15\u0026ndash;18 years.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003e2.3. Statistical analysis\u003c/h2\u003e\n \u003cp\u003eDemographic and clinical variables were summarised using descriptive statistics. Frequency counts and proportions were used to calculate the overall prevalence of early life trauma within the sample of women with endometriosis, as well as the specific type of unique or co-occurring abuse experienced. The prevalence of emotional abuse, physical abuse, neglect, and sexual abuse in our participants was firstly compared to our total cohort of women with endometriosis, and secondly to the general female population in Australia, derived from the Australian Child Maltreatment Study (Mathews et al. \u003cspan citationid=\"CR16\"\u003e2023\u003c/span\u003e). Significance was determined using the \u0026chi;\u003csup\u003e2\u003c/sup\u003e statistic for categorical variables. The unadjusted odds ratio (OR) and accompanying 95% confidence interval (CI) were estimated for the types of trauma and age groups, with the 0\u0026ndash;5 years group used as a reference group in all comparisons. OR was also employed in sensitivity analysis to explore the differences of prevalence across age groups in physical or mental health conditions. Statistical analysis was performed using R (Version 4.2.2, \u003cspan\u003e\u003cspan\u003ehttps://www.r-project.org/\u003c/span\u003e\u003c/span\u003e), and the figures were made in GraphPad Prism version 10.0 (GraphPad Software, Boston, Massachusetts USA, \u003cspan\u003e\u003cspan\u003ewww.graphpad.com\u003c/span\u003e\u003c/span\u003e). Statistical significance was set at a \u003cem\u003ep\u003c/em\u003e value of \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1. Participant characteristics\u003c/h2\u003e\n \u003cp\u003eThe demographic and clinical characteristics of our sample of women with endometriosis (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;68) are summarised in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of participants was 41.6 years (SD\u0026thinsp;=\u0026thinsp;9.68), with age range of 23\u0026ndash;64 years.\u003c/p\u003e\n \u003cp\u003eThe majority of women (42.6%) were in their reproductive years, followed by perimenopause (32.4%). Four participants (5.9%) were pregnant at the time of the clinic visit. Eleven participants (16.2%) had previously undergone a hysterectomy.\u003c/p\u003e\n \u003cp\u003eAll women in our sample had received at least one mental health diagnosis currently or in the past, with the highest prevalences seen in complex trauma disorder (70.6%), major depressive disorder (63.2%), and premenstrual dysphoric disorder (48.5%). The most common comorbid physical health conditions were polycystic ovarian syndrome, chronic fatigue syndrome, fibromyalgia, and autoimmune disease (19.1%).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic and clinical characteristics for women with endometriosis (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003eMean age in years [SD], range\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e41.6 [9.68], 23\u0026ndash;64\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\n \u003cp\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNone/Studying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e19 (27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eCasual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePart-time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e16 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eFull-time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e19 (27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e11 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\n \u003cp\u003eHighest education completed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eYear 11\u0026ndash;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e5 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eVocational training (TAFE, diploma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e23 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePostgraduate degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e17 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e10 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\n \u003cp\u003eAlcohol use\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNo current use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e15 (22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eInfrequent or monthly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e23 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eDaily or almost daily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e9 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e21 (30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\n \u003cp\u003eCigarette use\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNon-smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e27 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eCurrent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e6 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePast smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e14 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e21 (30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\n \u003cp\u003eIllicit substance use\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e23 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eCurrent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e6 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e18 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e21 (30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\n \u003cp\u003eReproductive state\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eReproductive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e29 (42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePregnant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePerimenopause\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e22 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePost-menopause (natural)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e5 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePost-menopause (surgical)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e8 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePrevious hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e11 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\n \u003cp\u003eMental health diagnoses\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAny\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e68 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMajor depressive disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e43 (63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePerimenopausal depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e22 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePremenstrual dysphoric disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e33 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eGeneralised anxiety disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e27 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eComplex trauma disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e48 (70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eOther psychiatric condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e38 (55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\n \u003cp\u003ePhysical health diagnoses\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eHyperlipidaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e10 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePolycystic ovarian syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eChronic fatigue syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eFibromyalgia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eIrritable bowel syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e10 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAutoimmune condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eOther physical condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e42 (61.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eSome participants were diagnosed with \u0026gt;\u0026thinsp;1 condition; N, number of participant; SD, standard deviation.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2. Prevalence of early life trauma (type)\u003c/h2\u003e\n \u003cp\u003eA high proportion of our sample of women with endometriosis experienced early life trauma, with 86.8% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;59) reporting a history of at least one of emotional abuse, physical abuse, neglect, or sexual abuse. Most women with a history of early life trauma experienced one type of trauma alone (35.3%), and emotional abuse was the type of trauma most commonly reported (76.5%). These findings are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePrevalences and ages of early life trauma (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003eAny experience of early life trauma\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eTotal, \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cem\u003eComparative test\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e59 (86.8)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNumber of types of trauma experienced\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e8 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e24 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e18 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e18 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\n \u003cp\u003eAge of abuse experienced (\u003cem\u003eN\u0026thinsp;=\u003c/em\u003e\u0026thinsp;59) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e0\u0026ndash;5 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e42 (71.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e6\u0026ndash;10 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e51 (86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e11\u0026ndash;14 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e49 (83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e15\u0026ndash;18 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e42 (71.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eExperience of trauma throughout childhood (all age groups 0\u0026ndash;18 years old)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e30 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;6.3, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eEmotional abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e52 (76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e0\u0026ndash;5 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e38 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;23.6, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e6\u0026ndash;10 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e46 (88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;39.8, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e11\u0026ndash;14 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e46 (88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;39.8, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e15\u0026ndash;18 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e37 (71.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;22.2, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePhysical abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e18 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e0\u0026ndash;5 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e8 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;21.1, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e6\u0026ndash;10 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;40.10, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e11\u0026ndash;14 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e12 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;36.02, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e15\u0026ndash;18 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e9 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;24.6, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNeglect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e24 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e0\u0026ndash;5 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e17 (70.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;37.9, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e6\u0026ndash;10 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e20 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;48.0, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e11\u0026ndash;14 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e20 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;48.0, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e15\u0026ndash;18 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e19 (79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;44.5, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eSexual abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e27 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e0\u0026ndash;5 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e8 (29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;11.0, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e6\u0026ndash;10 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e15 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;26.1, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e11\u0026ndash;14 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e11 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;17.0, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e15\u0026ndash;18 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026chi; 2\u0026thinsp;=\u0026thinsp;21.39, \u003cstrong\u003ep\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eComparative analysis was not completed for \u003cem\u003eAny experience of early life trauma\u003c/em\u003e, \u003cem\u003eNumber of types of early life trauma experienced\u003c/em\u003e, and \u003cem\u003eAge of abuse experienced\u003c/em\u003e; \u003cem\u003eN\u003c/em\u003e, number of participants; \u003cem\u003ep\u003c/em\u003e, p value\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3. Prevalence of early life trauma (age)\u003c/h2\u003e\n \u003cp\u003eEarly life trauma was experienced throughout childhood across all four age groups (0\u0026ndash;5, 6\u0026ndash;10, 11\u0026ndash;14, 15\u0026ndash;18) for 44.1% of participants. 9 participants (13.2%) reported early life trauma limited within a single age category. Of the 59 participants reporting early life trauma, the age range at which this was most frequently experienced was 6\u0026ndash;10 years of age (86.4%), closely followed by 11\u0026ndash;14 years (83.1%). These findings are summarised in Figs. \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eIn the sensitivity analysis, the prevalence of emotional abuse in 6\u0026ndash;10 years group and 11\u0026ndash;14 years group were significantly higher than in the reference group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03, respectively) in the population with generalized anxiety disorder as presented in the supplementary table (Online Resource 1).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4. Comparison with general population\u003c/h2\u003e\n \u003cp\u003eThe prevalence of early life trauma in our sample of women with endometriosis was greater compared to the general Australian female population (Mathews et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) for emotional abuse, sexual abuse, and neglect (Fig. \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e.\u003c/p\u003e\n \u003cp\u003eCompared to the general population, the prevalences of emotional abuse and neglect were significantly greater in our sample by 39.2% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 24.5% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively (Fig. \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Sexual abuse was greater in our sample by 2.4% but not significantly different. Conversely, the prevalence of physical abuse was lower in our sample compared to the general female Australian population by 5%.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe primary aim of this study was to investigate whether the prevalence of childhood trauma in a clinical sample of women with endometriosis was higher compared to the general Australian female population. The secondary aim was to evaluate the relevance of age and type of early life trauma experience in this cohort.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Prevalence of trauma\u003c/h2\u003e \u003cp\u003eOur study found a high prevalence of trauma in women with endometriosis, with 86.8% of participants reporting experiencing childhood trauma. This finding is supported by the HPA axis model linking stress with excess cortisol production and neuroendocrine changes (Westfall \u0026amp; Nemeroff \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In particular, long-term consequences of repeated exposure to early life stress include downstream effects of HPA axis dysfunction, including immune dysregulation and compromised reproductive health, both pathophysiological features of endometriosis (Abramiuk et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e;Neigh et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePast studies also support early life trauma as having a role in chronic inflammation (Grewal et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Bertone-Johnson et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) found that women who reported childhood sexual abuse had higher plasma levels of interleukin-6 and C-reactive protein than those who did not, suggesting that early life abuse may contribute to chronic inflammation through dysregulated immune function. Moreover, Kerr et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) established a significant association between early life trauma and increased inflammation when compared to controls without past exposure to trauma. This is potentially important when considering inflammation as a pathogenic hallmark of endometriosis, explained by mechanisms of peritoneal macrophage infiltration and local proinflammatory mediators (Parazzini et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2017\u003c/span\u003e;Wu et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Epidemiologically, these findings may be linked to the overall comparatively higher prevalence of early life trauma observed in our endometriosis sample.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Type of trauma\u003c/h2\u003e \u003cp\u003eOur results showed prevalence rates of different types of childhood trauma ranging from 26.5% to 76.5%. There was a significantly higher prevalence of early life emotional abuse and neglect in women with endometriosis compared to the general female population, suggesting that women with endometriosis are more likely to have experienced these specific types of early life trauma. Our findings are consistent with Liebermann et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), who found that childhood emotional abuse and neglect were significantly associated with endometriosis. The lower prevalences of physical and sexual abuse observed in our cohort are also in line with studies by Schliep et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), however, they contrast with the findings of Tietjen et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), who found significant associations with physical abuse, sexual abuse, and emotional abuse.\u003c/p\u003e \u003cp\u003eThe significant downstream impacts following emotional abuse and neglect in early life may be due to a variety of mechanisms. Existing literature has suggested that childhood emotional abuse is the most harmful type of early life trauma for children (Gibb \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). In these instances, this may be due to the caregiving role the perpetrator typically holds in relation to the victim, which involves a violation of the love and respect usually expected (Kulkarni et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Emotional abuse also tends to be more verbal, enabling greater internalisation of negative self-perceptions in the victim (Sachs-Ericsson et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Age of trauma\u003c/h2\u003e \u003cp\u003eOverall, across all types of trauma, childhood trauma occurring between the ages of 6\u0026ndash;10 and 16\u0026ndash;14 was more common than other age groups at prevalences of 86.4% and 83.1%, respectively. This may reflect the age-dependent neurobiological developmental processes in which rapid brain changes are observed in specific developmentally sensitive periods of childhood (Thomas et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Trauma in early life may also be more harmful than trauma experienced later in life, as it interferes with a child\u0026rsquo;s ability to effectively navigate critical developmental milestones, such as forming secure attachments and self-regulation (Dunn et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Similarly, Jean Piaget\u0026rsquo;s theory of cognitive development also represents middle childhood as a critical period for shifts in egocentrism and mentalisation (Piaget \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1971\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe found that 44.1% of women experienced early life trauma throughout childhood, between the ages 0\u0026ndash;18. This finding reflects a high prevalence of chronic early life trauma in our sample of women with endometriosis. In comparison, only 13.2% of participants experienced trauma within an isolated age group. This may suggest that prolonged exposure to trauma throughout childhood is more strongly associated with endometriosis rather than a specific age of exposure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.4. Limitations and implications\u003c/h2\u003e \u003cp\u003eSeveral limitations need to be taken into consideration. Firstly, there was inherent sampling bias in our participant group, given our participants were recruited from a specialist consultation clinic for women with complex psychiatric concerns, therefore impacting generalisability to the general female population.\u003c/p\u003e \u003cp\u003eThe data from this study were obtained cross-sectionally from participants\u0026rsquo; retrospective self-reports, thus enabling a degree of recall bias. As such, it is possible that childhood trauma occurring in the 0\u0026ndash;5 age group was also underreported. Moreover, although trauma history was ascertained through clinical interview by experienced clinicians, this was not carried out through standardised methods of assessing trauma, for example, through a validated questionnaire or survey. However, it should be noted that there has been a high convergent validity between self-report questionnaires and comprehensive interviews (Gayer-Anderson et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, there was no healthy control group to compare trauma characteristics and prevalence with our endometriosis sample. Instead, prevalence figures of the general female Australian population were utilised as a point of comparison. As a result, descriptive comparisons of participant demographic characteristics and age of trauma were unable to be undertaken.\u003c/p\u003e \u003cp\u003eWhile some previous research has investigated the prevalence of trauma in individuals with endometriosis (Harris et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e;Liebermann et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e;Tietjen et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), to our knowledge, this is the first study to explore the ages at which trauma was experienced. Our study also indicates a need for further research investigating emotional abuse and neglect specifically, given these types of trauma are generally less studied than physical and sexual abuse (Harris et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e;Schliep et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e;Tietjen et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Our findings suggest a significant difference may exist between certain types and ages of childhood trauma and the development of endometriosis. By identifying high prevalence rates of early life trauma in women with endometriosis, our findings support the importance of assessing prior trauma when obtaining a comprehensive clinical history in patients with endometriosis. Likewise, targeted screening for trauma and specific abuse profiles may assist clinicians in identifying individuals at higher risk of developing endometriosis. A focus on effective prevention and intervention of early life trauma is likely essential to mitigate the many long-term health consequences and other downstream effects of trauma that can arise.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOur cohort of women with endometriosis had a significantly higher prevalence of early life emotional abuse and neglect compared to the general Australian population. Additionally, prolonged exposure to trauma throughout childhood may increase the risk of developing endometriosis. Our study contributes to understandings of the relationship between early life trauma and endometriosis. More research is necessary to further characterise this relationship in future studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003ethis research received no external funding.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eL.C.: Methodology, Formal Analysis, Investigation, Writing \u0026ndash; Original draft preparation, Visualisation. E.M.: Methodology, Supervision, Writing \u0026ndash; Reviewing and Editing.Q.L.: Formal Analysis, Visualisation. L.I.: Formal Analysis. J.K.: Conceptualisation, Supervision, Writing \u0026ndash; Reviewing and Editing.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe thank the women for participating in this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbramiuk, M., Grywalska, E., Małkowska, P., Sierawska, O., Hrynkiewicz, R., \u0026amp; Niedźwiedzka-Rystwej, P. (2022). The Role of the Immune System in the Development of Endometriosis. \u003cem\u003eCells\u003c/em\u003e,\u003cem\u003e 11\u003c/em\u003e(13). https://doi.org/10.3390/cells11132028\u003c/li\u003e\n\u003cli\u003eBertone-Johnson, E. R., Whitcomb, B. W., Missmer, S. A., Manson, J. E., Hankinson, S. E., \u0026amp; Rich-Edwards, J. W. (2014). 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K., Mataix-Cols, D., Fern\u0026aacute;ndez de la Cruz, L., Almqvist, C., Fall, K., \u0026amp; Valdimarsd\u0026oacute;ttir, U. A. (2018). Association of Stress-Related Disorders With Subsequent Autoimmune Disease. \u003cem\u003eJAMA\u003c/em\u003e,\u003cem\u003e 319\u003c/em\u003e(23), 2388-2400. https://doi.org/10.1001/jama.2018.7028\u003c/li\u003e\n\u003cli\u003eThomas, N., Gurvich, C., \u0026amp; Kulkarni, J. (2019). Borderline personality disorder, trauma, and the hypothalamus-pituitary-adrenal axis. \u003cem\u003eNeuropsychiatr Dis Treat\u003c/em\u003e,\u003cem\u003e 15\u003c/em\u003e, 2601-2612. https://doi.org/10.2147/ndt.S198804\u003c/li\u003e\n\u003cli\u003eTietjen, G. E., Brandes, J. L., Peterlin, B. L., Eloff, A., Dafer, R. M., Stein, M. R., Drexler, E., Martin, V. T., Hutchinson, S., Aurora, S. K., Recober, A., Herial, N. A., Utley, C., White, L., \u0026amp; Khuder, S. A. (2010). Childhood Maltreatment and Migraine (Part III). 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Epidemiology of endometriosis-associated infertility. \u003cem\u003eJ Reprod Med\u003c/em\u003e,\u003cem\u003e 34\u003c/em\u003e(1), 41-46.\u003c/li\u003e\n\u003cli\u003eWirtz, P. H., \u0026amp; von K\u0026auml;nel, R. (2017). Psychological Stress, Inflammation, and Coronary Heart Disease [Review]. \u003cem\u003eCurrent Cardiology Reports\u003c/em\u003e,\u003cem\u003e 19\u003c/em\u003e(11), Article 111. https://doi.org/10.1007/s11886-017-0919-x\u003c/li\u003e\n\u003cli\u003eWu, M.-H., Hsiao, K.-Y., \u0026amp; Tsai, S.-J. (2015). Endometriosis and possible inflammation markers. \u003cem\u003eGynecology and Minimally Invasive Therapy\u003c/em\u003e,\u003cem\u003e 4\u003c/em\u003e(3), 61-67. https://doi.org/https://doi.org/10.1016/j.gmit.2015.05.001\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9496409/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9496409/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eEndometriosis is a common chronic inflammatory gynaecological condition characterised by the abnormal presence of endometrial tissue outside the uterus. Different risk factors for endometriosis have been proposed, with some research finding a significant relationship between endometriosis and early life trauma. This study aimed to determine the prevalence, age, and type of early life trauma in a clinical sample of women with existing diagnosis of endometriosis compared with the prevalence in the general Australian female population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eParticipants were recruited from the Multidisciplinary Alfred Psychiatry research centre Women\u0026rsquo;s Mental Health Clinic (WMHC). Women who self-reported a diagnosis of endometriosis were identified from the WMHC patient database, established in 2017. In patients who reported a presence of early life trauma, information regarding the type and age of the early traumatic experience(s) was recorded. The prevalence of each type of trauma in our participants was compared to the general female population in Australia.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 68 included participants, the mean (SD) age was 41.6 (9.7) years. 86.8% of participants (n\u0026thinsp;=\u0026thinsp;59) reported experience of any early life trauma, most commonly occurring between ages 6\u0026ndash;10 (89.8%). The most reported type of trauma was emotional abuse (76.5%). Compared to the general female population, the prevalence of emotional abuse (76.5% vs 37.3%), neglect (35.3% vs 10.8%), and sexual abuse (39.7% vs 37.3%) were higher in our sample.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings of this study found high prevalence rates of early life trauma, in particular emotional abuse and neglect, in women with endometriosis.\u003c/p\u003e","manuscriptTitle":"Early life trauma and endometriosis: a case-control study on type and timing of adverse experiences","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-19 06:23:46","doi":"10.21203/rs.3.rs-9496409/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff272841-d5aa-49ed-b081-aa8915048988","owner":[],"postedDate":"May 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T06:23:46+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-19 06:23:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9496409","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9496409","identity":"rs-9496409","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}