Gut Issues, Anxiety and Bladder Pain May Trace Back to One Condition

Endometriosis is often described as a condition of painful periods and lesions in the pelvis. But according to Hugh Taylor, M.D., chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine, that view is far too narrow.

The lesions create inflammation that signals throughout the body, affecting multiple organ systems, Taylor explained. The condition affects up to 10% of reproductive-age women, he said, yet it often goes unrecognized for years.

An inflammatory disease that reaches beyond the pelvis

Women with endometriosis are much more likely to have depression and anxiety, and Taylor said research has shown the condition can directly affect the brain. It can also change how fat cells and the liver function, altering metabolism.

His research has also linked endometriosis to a higher risk of atherosclerosis, or hardening of the arteries, later in life, even after the endometriosis itself may be gone. The inflammation can affect blood vessels directly, he said.

Gut and bladder symptoms often sent to other specialists

Taylor said many patients are referred to gastroenterologists for bowel symptoms and undergo colonoscopies that come back normal. In many cases, the endometriosis hasn’t grown into the intestines. Instead, inflammation throughout the pelvis irritates the bowels, and the bladder can be affected the same way.

Rather than treating irritable bowel symptoms, bladder pain, depression, anxiety and metabolic concerns as separate diagnoses, he encourages clinicians to consider whether one disease may explain them. “It may all just simply be due to one disease, endometriosis,” he said. Treating the endometriosis first can reveal which symptoms, if any, remain.

The one kind of pain people call normal

Part of the reason endometriosis is overlooked, Taylor said, is that menstrual cramps are widely accepted. “It’s the only pain we as human beings would ever consider normal,” he said.

Pain is also subjective and hard to measure. Many patients have told him that friends, family and even physicians dismissed their severe cramps until they began missing school or work.

Cramps that worsen with age deserve attention

Taylor suggests comparing current pain with the cramps experienced during the first year after periods began. If the pain has steadily increased since then, that’s a sign something may be wrong.

“Menstrual pain is not supposed to get worse as you get older,” he said. He encourages patients not to wait until pain becomes debilitating and to seek out a physician familiar with endometriosis.

A faster path to diagnosis and treatment

Historically, diagnosing endometriosis has required surgery, and patients wait an average of 4 to 11 years after symptoms begin to get a diagnosis. In March 2026, the American College of Obstetricians and Gynecologists issued guidance supporting a clinical diagnosis based on a patient’s history, symptoms and physical exam, without requiring surgery first.

Taylor called the change refreshing and said it could speed up diagnosis and treatment. “If it sounds like endometriosis, it probably is,” he said.

First-line treatment is often a birth control pill, which doesn’t work for everyone but can relieve pain for many patients and help them get back to school, work and their normal lives.