Endometriosis, Self-Compassion and the Pain Cycle: How We Respond Matters

What is endomedtriosis?

Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus grows in places outside the uterus, such as around the ovaries, fallopian tubes, bowel, bladder and other areas of the pelvis. This tissue can respond to hormonal changes throughout the menstrual cycle, contributing to inflammation, irritation and scar tissue, which can lead to symptoms such as pelvic pain, painful periods, pain with sex, bowel or bladder symptoms, fatigue and difficulties with fertility.

We still don’t know exactly why endometriosis develops – however we do know that it is not isolated to a ‘reproductive condition’, as is often thought. Rather than having one single cause, it is thought to involve a combination of factors including genetics, immune-system function, inflammation, hormonal influences - particularly the way endometriosis responds to oestrogen - and how certain cells develop and behave.

The severity of symptoms does not always match the amount of endometriosis present - someone with relatively little visible disease can experience significant pain, while another person with more extensive disease may have fewer symptoms. 

Living with endometriosis can mean living with pain that is persistent, unpredictable and, at times, difficult for others to understand.

But the impact of endometriosis goes far beyond physical symptoms. Chronic pelvic pain, fatigue, concerns about fertility and long delays in diagnosis can take an emotional toll. For many people, this can contribute to stress, anxiety, depression and reduced quality of life.

So, what can help break this cycle?

New research suggests that self-compassion may play a role — particularly by reducing something known as pain catastrophising.

What is pain catastrophising?

Pain catastrophising is a pattern of thinking that can develop when we experience persistent pain.

It may involve:

• constantly thinking about the pain;

• expecting the worst possible outcome;

• feeling helpless or unable to cope; and

• focusing intensely on how severe or threatening the pain feels.

Pain catastrophising does not mean that the pain isn't real. Endometriosis pain is real, and it can be severe and disabling.

Recognising the psychological processes surrounding pain is not about blaming someone for their symptoms or suggesting that the pain is "all in their head."

Instead, it is about understanding how the brain, emotions and physical experience of chronic pain can interact.

Where does self-compassion come in?

Self-compassion means responding to ourselves with the kindness, understanding and patience that we might offer someone we care about.

For someone living with endometriosis, this could mean replacing thoughts such as:

"I should be able to cope with this."

or

"Why can't I just get on with things like everyone else?"

with something more supportive:

"I'm dealing with something genuinely difficult, and it's understandable that I'm struggling today."

This doesn't make the pain disappear, and it doesn't mean giving up on treatment. It certainly doesn't mean accepting inadequate healthcare.

Instead, self-compassion may help reduce some of the additional emotional suffering that can develop around chronic pain.

Research backed

A recent study by Skinner and Kuijer (2025) followed people with endometriosis over six months to explore the relationship between self-compassion, psychological wellbeing and quality of life.

The researchers found that people with higher levels of self-compassion tended to experience:

• lower psychological distress;

• less depression;

• less anxiety and stress; and

• better health-related quality of life.

These findings suggest that self-compassion may be an important factor in psychological wellbeing for people living with endometriosis.

Self-compassion and catastrophising

One possible explanation is the relationship between self-compassion and pain catastrophising.

When pain is persistent, frightening or unpredictable, it can be easy to become caught in a cycle where pain leads to thoughts of helplessness or fear, which can then contribute to greater emotional distress.

The research suggests that self-compassion may help interrupt this cycle by reducing catastrophising and self-criticism.

Importantly, this does not mean that self-compassion cures endometriosis or removes physical pain. Nor does it mean that people can simply change their thoughts and magically feel better.

Rather, it suggests that changing the way we respond to ourselves when we are in pain may help reduce some of the psychological burden of living with a chronic condition.

Why this matters

Endometriosis is often discussed as a reproductive or gynaecological condition. But for the person experiencing it, the reality is much broader.

Living with chronic pain can affect relationships, work, education, social activities, sleep and mental health. Diagnostic delays — or having symptoms questioned or dismissed — can add another layer of frustration and uncertainty.

This is why endometriosis care needs to look beyond physical symptoms alone.

Psychological support should never be used to dismiss someone's pain. Instead, it should be part of genuinely holistic care, alongside appropriate medical assessment, pain management and treatment.

The message should be simple:

Your pain is real, and you deserve support in dealing with everything that comes with it.

Self-compassion isn't self-blame

This distinction is incredibly important.

There is a risk that conversations about psychological approaches to chronic pain can unintentionally make people feel responsible for their symptoms. If someone is experiencing severe endometriosis pain, telling them to "think positively" or "be more compassionate towards yourself" is not an adequate response.

That is not what self-compassion is about.

Self-compassion should never replace appropriate medical care, pain management or treatment. Instead, it can be viewed as another tool in the toolbox — one that may help someone cope with the emotional and psychological challenges that accompany persistent pain.

What can self-compassion look like in everyday life?

Self-compassion doesn't have to involve complicated exercises. It can begin simply by noticing how you speak to yourself when symptoms flare.

Instead of:

"I'm useless because I've had to cancel again."

Try:

"I'm disappointed that I had to cancel, but my body is struggling today. Resting doesn't make me useless."

Instead of:

"I'll never get better."

Try:

"I'm frightened about how long this will last. I don't know what the future holds, but I can focus on what I need today."

And instead of:

"Other people manage this. Why can't I?"

Try:

"My experience is different from theirs. I don't need to prove that my pain is serious."

These small shifts don't invalidate the reality of chronic pain. They may simply prevent pain from creating another source of suffering through harsh self-judgement.

A more compassionate approach to endometriosis care

Perhaps the biggest lesson is that psychological wellbeing should not be treated as separate from physical health.

Someone living with endometriosis may need medical treatment, pain management, practical support and psychological support — and, perhaps most importantly, to feel seen and heard.

Self-compassion may be one way of developing greater resilience in the face of chronic pain. By reducing self-criticism and potentially helping to reduce catastrophising, it may help people regain a sense of control over one part of an experience that can otherwise feel completely outside their control.

And that is an important distinction.

Self-compassion isn't about telling yourself that the pain isn't serious. It's about recognising that the pain is serious while also choosing not to make yourself suffer for having it.

Learning to respond to yourself with compassion rather than criticism may be one small but valuable way of living with a very difficult condition.

Written by Conor Fogarty Clinical Psychologist www.annacentre.com.au

Reference:  

Sara Harris, Women’s Health Therapist.

Chelsea Skinner, Roeline Kuijer (2025). The role of self-compassion in protecting psychological wellbeing and health-related quality of life in those with endometriosis: A prospective study. Journal of Psychosomatic Research, 196, 112322.