A systematic review and meta-analysis of the relationship between emotion regulation, pain, depressive symptoms and quality of life in women with endometriosis

Abstract

Background: Endometriosis is a chronic gynecological condition with a broad spectrum of symptomatology resulting from a complex pathophysiology and biopsychosocial etiology, to which emotion regulation (ER) seems to contribute. This systematic review aims to summarize and meta-analyse the empirical evidence for the relationship between (mal)adaptive ER strategies, pain (intensity and impact), depressive symptoms, and quality of life of women with endometriosis.

Design and methods: After registering to PROSPERO (ID: CRD42023427936; redacted), four databases were searched (PubMed, PsycINFO, Web of Knowledge, Scopus) from inception until 30th May 2025. All screening steps were performed by two researchers independently. The quality of the studies was examined using the National Heart, Lung and Blood Institute tool, and statistical analyses were performed on R.

Results: Sixteen studies (N = 3687) were included. Pooled correlations found ER to be significantly correlated with all outcomes, with adaptive (e.g., acceptance, mindfulness, self-compassion) and maladaptive (e.g., rumination, catastrophizing) ER strategies being associated with the outcomes in the expected direction. Age moderated the association between ER and quality of life, showing that ER especially moderates quality of life in younger women with endometriosis.

Conclusions: This meta-analysis provides evidence that adaptive ER skills might positively influence symptomatology in younger women with endometriosis. To foster mental health and pain coping, psychological management with a focus on emotion regulation may help the field further.

Keywords: Emotion regulation; Endometriosis; Mental health; Meta-analysis; Pain.